Provider Demographics
NPI:1346456514
Name:BRIGHT STAR DENTAL
Entity Type:Organization
Organization Name:BRIGHT STAR DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-526-4334
Mailing Address - Street 1:2001 E LOHMAN AVE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3167
Mailing Address - Country:US
Mailing Address - Phone:505-526-4334
Mailing Address - Fax:505-526-7863
Practice Address - Street 1:2001 E LOHMAN AVE
Practice Address - Street 2:SUITE 121
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3167
Practice Address - Country:US
Practice Address - Phone:505-526-4334
Practice Address - Fax:505-526-7863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1674122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty