Provider Demographics
NPI:1003088873
Name:BRIGHT SMILES, LLC
Entity Type:Organization
Organization Name:BRIGHT SMILES, LLC
Other - Org Name:BRIGHT SMILES ORTHODONTICS AND PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHUNDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:678-583-8536
Mailing Address - Street 1:907 PAVILION CT
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6665
Mailing Address - Country:US
Mailing Address - Phone:678-583-8536
Mailing Address - Fax:678-583-8657
Practice Address - Street 1:907 PAVILION CT
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6665
Practice Address - Country:US
Practice Address - Phone:678-583-8536
Practice Address - Fax:678-583-8657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0126491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1235292897Medicaid
GA9181762OtherGA PROVIDER NUMBER
GA1585058OtherUNITED CONCORDIA
GA9199332OtherGA PROVIDER ID
GA100486OtherGA PROVIDER ID
GA101869OtherGA PROVIDER ID