MEDICARE: THE BRIGHT SMILE CENTER, BEREA, 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
1	1223G0001X	General Practice Dentistry	3174	SC

General Provider Information

NPI Number	:	1952684300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE BRIGHT SMILE CENTER, BEREA, PA

Provider Business Mailing Address
First Line	:	PO BOX 204
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29641-0204
Country	:	US
Telephone Number	:	864-295-0441
Fax Number	:	864-295-0184

Provider Business Practice Location Address
First Line	:	103 COMMONS WAY
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-3850
Country	:	US
Telephone Number	:	864-295-0441
Fax Number	:	864-295-0184

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MISS ANGELA CAROL BAKER
Credential	:	RDH
Telephone Number	:	864-295-0441

Provider Enumeration Date	:	09/22/2011
Last Update Date	:	09/22/2011

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