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NPI Code Detail

MEDICARE: BRIGHT VALUE DENTAL PA

MEDICARE: BRIGHT VALUE DENTAL PA
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
1122300000XDentist30113TX
2122300000XDentist30300TX

General Provider Information

NPI Number : 1790174001
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRIGHT VALUE DENTAL PA
Provider Business Mailing Address
First Line : 3434 GOODHOPE ST
Second Line :
City : HOUSTON
State : TX
Zip : 77021-5908
Country : US
Telephone Number : 832-322-2310
Fax Number :
Provider Business Practice Location Address
First Line : 5716 BELLAIRE BLVD STE B
Second Line :
City : HOUSTON
State : TX
Zip : 77081-5512
Country : US
Telephone Number : 832-316-0369
Fax Number :
Authorized Official
Title or Position : CEO
Name : DR. DEREK XU LIANG
Credential : DDS
Telephone Number : 832-316-0369
Provider Enumeration Date : 01/10/2015
Last Update Date : 01/10/2015

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Directions to “BRIGHT VALUE DENTAL PA ” Practice Location

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