Provider Demographics
NPI:1568611937
Name:BRIGHT WHITE DENTAL, PLLC
Entity Type:Organization
Organization Name:BRIGHT WHITE DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SALAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFAILOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-730-9222
Mailing Address - Street 1:18706 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1705
Mailing Address - Country:US
Mailing Address - Phone:718-730-9222
Mailing Address - Fax:718-730-9117
Practice Address - Street 1:18706 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1705
Practice Address - Country:US
Practice Address - Phone:718-730-9222
Practice Address - Fax:718-730-9117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0528501223G0001X
NY0539161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty