Provider Demographics
NPI:1609242635
Name:BRIGHTSMILES4KIDS, LLC
Entity Type:Organization
Organization Name:BRIGHTSMILES4KIDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANGITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-979-0606
Mailing Address - Street 1:121 SHELLEY DR STE 1A-1B
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2530
Mailing Address - Country:US
Mailing Address - Phone:908-979-0606
Mailing Address - Fax:908-979-9996
Practice Address - Street 1:121 SHELLEY DR STE 1A-1B
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2530
Practice Address - Country:US
Practice Address - Phone:908-979-0606
Practice Address - Fax:908-979-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI17807261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental