Provider Demographics
NPI:1285012278
Name:SMILE BRIGHT DENTAL, CW, LLC
Entity Type:Organization
Organization Name:SMILE BRIGHT DENTAL, CW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-885-3900
Mailing Address - Street 1:1237 S MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-9111
Mailing Address - Country:US
Mailing Address - Phone:727-443-7353
Mailing Address - Fax:727-443-2144
Practice Address - Street 1:1237 S MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-9111
Practice Address - Country:US
Practice Address - Phone:727-443-7353
Practice Address - Fax:727-443-2144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14915302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization