MEDICARE: BRIGHT SMILE DENTAL CARE, PSC

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	122300000X	Dentist	8387	KY
2	122300000X	Dentist	9059	KY
3	122300000X	Dentist	8112	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487921466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT SMILE DENTAL CARE, PSC

Provider Business Mailing Address
First Line	:	60 STONECREST CT
Second Line	:	SUITE 200
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-8155
Country	:	US
Telephone Number	:	502-633-1819
Fax Number	:	502-633-1817

Provider Business Practice Location Address
First Line	:	60 STONECREST CT
Second Line	:	SUITE 200
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-8157
Country	:	US
Telephone Number	:	502-633-1819
Fax Number	:	502-633-1817

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. SANA M ABUROB
Credential	:	D.M.D
Telephone Number	:	270-734-1967

Provider Enumeration Date	:	11/19/2011
Last Update Date	:	01/18/2012

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