Provider Demographics
NPI:1366822710
Name:A BRIGHTER SMILE
Entity Type:Organization
Organization Name:A BRIGHTER SMILE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CLERK
Authorized Official - Prefix:
Authorized Official - First Name:INGER
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-688-9330
Mailing Address - Street 1:385 BERT KOUNS LOOP
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-8158
Mailing Address - Country:US
Mailing Address - Phone:318-688-9330
Mailing Address - Fax:318-688-1183
Practice Address - Street 1:385 BERT KOUNS LOOP
Practice Address - Street 2:SUITE 700
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-8158
Practice Address - Country:US
Practice Address - Phone:318-688-9330
Practice Address - Fax:318-688-1183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA58311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty