Provider Demographics
NPI:1477725570
Name:BRIGHT SMILES
Entity Type:Organization
Organization Name:BRIGHT SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCO/LEAD DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:618-580-5988
Mailing Address - Street 1:702 BARON DR
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-1013
Mailing Address - Country:US
Mailing Address - Phone:618-277-5988
Mailing Address - Fax:618-277-3088
Practice Address - Street 1:702 BARON DR
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-1013
Practice Address - Country:US
Practice Address - Phone:618-277-5988
Practice Address - Fax:618-277-3088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019021899122300000X
IL019022712122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty