Provider Demographics
NPI:1285190777
Name:SMILE BRITE DENTAL & ORTHODONTICS
Entity Type:Organization
Organization Name:SMILE BRITE DENTAL & ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-254-4211
Mailing Address - Street 1:113 RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6793
Mailing Address - Country:US
Mailing Address - Phone:817-751-1777
Mailing Address - Fax:
Practice Address - Street 1:113 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6793
Practice Address - Country:US
Practice Address - Phone:817-751-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty