MEDICARE: BRIGHTON SMILES - GASPAR PLLC

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	1223G0001X	General Practice Dentistry	22362	TX

General Provider Information

NPI Number	:	1609116011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTON SMILES - GASPAR PLLC

Provider Business Mailing Address
First Line	:	5401 FM 1626
Second Line	:	#190
City	:	KYLE
State	:	TX
Zip	:	78640-6038
Country	:	US
Telephone Number	:	512-268-3384
Fax Number	:	512-268-4800

Provider Business Practice Location Address
First Line	:	5401 FM 1626
Second Line	:	#190
City	:	KYLE
State	:	TX
Zip	:	78640-6038
Country	:	US
Telephone Number	:	512-268-3384
Fax Number	:	512-268-4800

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. EUGENE CHRISTOPHER GASPAR
Credential	:	DDS
Telephone Number	:	512-268-3384

Provider Enumeration Date	:	02/21/2013
Last Update Date	:	02/21/2013

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