Provider Demographics
NPI:1568702041
Name:OPEN BRIGHT PEDIATRIC DENTISTRY P.C.
Entity Type:Organization
Organization Name:OPEN BRIGHT PEDIATRIC DENTISTRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HYACINTHE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:347-292-1757
Mailing Address - Street 1:2266 5TH AVE UNIT 1695
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-9464
Mailing Address - Country:US
Mailing Address - Phone:347-292-1757
Mailing Address - Fax:
Practice Address - Street 1:131 W 110TH ST APT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-4205
Practice Address - Country:US
Practice Address - Phone:347-292-1757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0528371223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03275569Medicaid