MEDICARE: DANBURY BRIGHT SMILES LLC

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
1	261QD0000X	Dental Clinic/Center
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1366279622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANBURY BRIGHT SMILES LLC

Provider Business Mailing Address
First Line	:	122 TOWER RD
Second Line	:
City	:	BROOKFIELD
State	:	CT
Zip	:	06804-3653
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 NORTH ST STE 411
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-5629
Country	:	US
Telephone Number	:	475-529-5893
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	ANUSHA ATIQUE
Credential	:	DDS
Telephone Number	:	475-529-5893

Provider Enumeration Date	:	09/18/2024
Last Update Date	:	09/18/2024

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