Provider Demographics
NPI:1386208197
Name:BRITE SMILES OF CALIFORNIA
Entity Type:Organization
Organization Name:BRITE SMILES OF CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MOBILE DENTAL HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:GIDLOF
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:760-625-3708
Mailing Address - Street 1:152 VIA SAN NICOLO
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-1803
Mailing Address - Country:US
Mailing Address - Phone:760-625-3708
Mailing Address - Fax:
Practice Address - Street 1:152 VIA SAN NICOLO
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-1803
Practice Address - Country:US
Practice Address - Phone:760-625-3708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty