Provider Demographics
NPI:1609422450
Name:BRIGHT SMILES PEDICARE, INC.
Entity Type:Organization
Organization Name:BRIGHT SMILES PEDICARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HUASCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-631-4926
Mailing Address - Street 1:2316 S RED RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2207
Mailing Address - Country:US
Mailing Address - Phone:786-631-4926
Mailing Address - Fax:786-703-7952
Practice Address - Street 1:2316 S RED RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2207
Practice Address - Country:US
Practice Address - Phone:786-631-4926
Practice Address - Fax:786-703-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy