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NPI Code Detail

MEDICARE: BRIGHT SMILES, DDS PC

MEDICARE: BRIGHT SMILES, DDS PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry0401008799VA

General Provider Information

NPI Number : 1194180760
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRIGHT SMILES, DDS PC
Provider Business Mailing Address
First Line : 1444 KEMPSVILLE ROAD
Second Line : SUITE 101
City : VIRGINIA BEACH
State : VA
Zip : 23464
Country : US
Telephone Number : 757-497-8611
Fax Number :
Provider Business Practice Location Address
First Line : 1444 KEMPSVILLE RD
Second Line : SUITE 101
City : VIRGINIA BEACH
State : VA
Zip : 23464-7302
Country : US
Telephone Number : 757-497-8611
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. LIDA SADR
Credential : DDS
Telephone Number : 703-862-3178
Provider Enumeration Date : 12/23/2015
Last Update Date : 12/23/2015

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