Provider Demographics
NPI:1568113082
Name:BRIGHT STARR PEDIATRIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:BRIGHT STARR PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EBONEE
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:THROWER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-764-5753
Mailing Address - Street 1:10201 MARTIN LUTHER KING JR HWY UNIT 240A
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4003
Mailing Address - Country:US
Mailing Address - Phone:240-764-5753
Mailing Address - Fax:240-764-5799
Practice Address - Street 1:10201 MARTIN LUTHER KING JR HWY UNIT 240A
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4003
Practice Address - Country:US
Practice Address - Phone:240-764-5753
Practice Address - Fax:240-764-5799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental