Provider Demographics
NPI:1124561360
Name:BRITE FAMILY DENTAL CARE
Entity Type:Organization
Organization Name:BRITE FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMSHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-486-4664
Mailing Address - Street 1:2772 E HENRIETTA RD
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467-9354
Mailing Address - Country:US
Mailing Address - Phone:585-486-4664
Mailing Address - Fax:585-486-4839
Practice Address - Street 1:2772 E HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467-9354
Practice Address - Country:US
Practice Address - Phone:585-486-4664
Practice Address - Fax:585-486-4839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-20
Last Update Date:2016-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0516671223G0001X
NY0537491223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03038951Medicaid