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NPI Code Detail

MEDICARE: BRIGHTER SMILE LLC

MEDICARE: BRIGHTER SMILE 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
1332BC3200XCustomized Equipment (DME)
2332B00000XDurable Medical Equipment & Medical Supplies
31223G0001XGeneral Practice Dentistry019028755IL

General Provider Information

NPI Number : 1740603331
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRIGHTER SMILE LLC
Provider Business Mailing Address
First Line : 4845 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-2145
Country : US
Telephone Number : 773-647-1093
Fax Number : 773-647-1704
Provider Business Practice Location Address
First Line : 4845 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-2145
Country : US
Telephone Number : 773-647-1093
Fax Number :
Authorized Official
Title or Position : DENTIST
Name : MICHELLE BECKERLY
Credential :
Telephone Number : 617-365-6261
Provider Enumeration Date : 02/03/2014
Last Update Date : 10/07/2025

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Directions to “BRIGHTER SMILE LLC ” Practice Location

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