Provider Demographics
NPI:1205013554
Name:BRIGHT SMILES, P.A.
Entity Type:Organization
Organization Name:BRIGHT SMILES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANKARI
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMARACHANDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-737-9666
Mailing Address - Street 1:4115 WILKENS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-4750
Mailing Address - Country:US
Mailing Address - Phone:410-737-9666
Mailing Address - Fax:410-737-9667
Practice Address - Street 1:4115 WILKENS AVE STE 101
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4750
Practice Address - Country:US
Practice Address - Phone:410-737-9666
Practice Address - Fax:410-737-9667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11814261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404887300Medicaid