Provider Demographics
NPI:1144524976
Name:BROOKLYN BRIGHT SMILE DENTAL, PC
Entity type:Organization
Organization Name:BROOKLYN BRIGHT SMILE DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDIYEV
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTHUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-696-1614
Mailing Address - Street 1:2020 CORTELYOU RD FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5904
Mailing Address - Country:US
Mailing Address - Phone:917-696-1614
Mailing Address - Fax:
Practice Address - Street 1:2020 CORTELYOU RD FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-5904
Practice Address - Country:US
Practice Address - Phone:917-696-1614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0539461122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0539461OtherSTATE LICENSE
NY03034879Medicaid
NY03034879Medicaid