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NPI Code Detail

MEDICARE: STAR BRIGHT ONSITE, LLC

MEDICARE: STAR BRIGHT ONSITE, 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
11223G0001XGeneral Practice Dentistry

Other Identifiers

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

General Provider Information

NPI Number : 1578105482
Entity Type Code : Organization
Provider Name (Legal Business Name) : STAR BRIGHT ONSITE, LLC
Provider Business Mailing Address
First Line : 201 DURSELY DR
Second Line :
City : ANDERSON
State : SC
Zip : 29621-3670
Country : US
Telephone Number : 864-221-5368
Fax Number :
Provider Business Practice Location Address
First Line : 6709 WHITE HORSE RD
Second Line :
City : GREENVILLE
State : SC
Zip : 29611-2503
Country : US
Telephone Number : 864-246-0260
Fax Number : 864-484-9449
Authorized Official
Title or Position : DENTIST
Name : ROBERT LESLIE THOMAS
Credential : DMD
Telephone Number : 864-221-5368
Provider Enumeration Date : 10/11/2019
Last Update Date : 10/11/2019

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Directions to “STAR BRIGHT ONSITE, LLC ” Practice Location

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