MEDICARE: BRIGHT SMILES DENTAL STUDIO,PA DBA

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	1223D0001X	Public Health Dentistry

General Provider Information

NPI Number	:	1760954408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT SMILES DENTAL STUDIO,PA DBA

Provider Business Mailing Address
First Line	:	730 GOODLETTE RD N STE 206
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-5618
Country	:	US
Telephone Number	:	239-262-4596
Fax Number	:	239-649-6702

Provider Business Practice Location Address
First Line	:	730 GOODLETTE RD N STE 206
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-5618
Country	:	US
Telephone Number	:	239-262-4596
Fax Number	:	239-649-6702

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. WISDOM D AKPAKA
Credential	:	DDS
Telephone Number	:	678-650-2198

Provider Enumeration Date	:	12/19/2018
Last Update Date	:	12/19/2018

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