MEDICARE: BRIGHT 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
1	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1790160844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT SMILE LLC

Provider Business Mailing Address
First Line	:	1605 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-1209
Country	:	US
Telephone Number	:	708-394-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-1209
Country	:	US
Telephone Number	:	708-394-5100
Fax Number	:

Authorized Official
Title or Position	:	CEO /PRESIDENT
Name	:	AHMED RAMAHA
Credential	:	DDS
Telephone Number	:	708-394-5100

Provider Enumeration Date	:	07/29/2015
Last Update Date	:	07/29/2015

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Directions to “BRIGHT SMILE LLC ” Practice Location

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