MEDICARE: BRIGHT SMILES COMMUNITY CLINIC & DENTAL

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1932934932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT SMILES COMMUNITY CLINIC & DENTAL

Provider Business Mailing Address
First Line	:	334 E LAKE ST STE 104
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2485
Country	:	US
Telephone Number	:	612-910-1131
Fax Number	:

Provider Business Practice Location Address
First Line	:	334 E LAKE ST STE 104
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2485
Country	:	US
Telephone Number	:	612-910-1131
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. MAHADO ONWUKWE
Credential	:
Telephone Number	:	612-910-1131

Provider Enumeration Date	:	09/09/2024
Last Update Date	:	01/13/2026

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