Provider Demographics
NPI:1083864102
Name:BRITE SMILEZ COSMETIC & FAMILY DENTISTRY
Entity Type:Organization
Organization Name:BRITE SMILEZ COSMETIC & FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST/ OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:615-866-9109
Mailing Address - Street 1:5245 HICKORY HOLLOW PKWY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3003
Mailing Address - Country:US
Mailing Address - Phone:615-866-9109
Mailing Address - Fax:615-866-9147
Practice Address - Street 1:5245 HICKORY HOLLOW PKWY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3003
Practice Address - Country:US
Practice Address - Phone:615-866-9109
Practice Address - Fax:615-866-9147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS2859122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440696Medicaid
TNQ014905Medicaid
TN1517984Medicaid