Provider Demographics
NPI:1184846677
Name:BRIGHT SMILE ASSOCIATES
Entity Type:Organization
Organization Name:BRIGHT SMILE ASSOCIATES
Other - Org Name:DEDICATED DENTALCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUVY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-846-5111
Mailing Address - Street 1:DEDICATED DENTALCARE SERVICES
Mailing Address - Street 2:1075 EASTON AVENUE
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873
Mailing Address - Country:US
Mailing Address - Phone:732-846-5111
Mailing Address - Fax:732-846-8485
Practice Address - Street 1:DEDICATED DENTALCARE SERVICES
Practice Address - Street 2:1075 EASTON AVENUE
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-846-5111
Practice Address - Fax:732-846-8485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI192101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1194874354Medicare UPIN