Provider Demographics
NPI:1194180760
Name:BRIGHT SMILES, DDS PC
Entity Type:Organization
Organization Name:BRIGHT SMILES, DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SADR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-862-3178
Mailing Address - Street 1:1444 KEMPSVILLE ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464
Mailing Address - Country:US
Mailing Address - Phone:757-497-8611
Mailing Address - Fax:
Practice Address - Street 1:1444 KEMPSVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-7302
Practice Address - Country:US
Practice Address - Phone:757-497-8611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010087991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty