Provider Demographics
NPI:1629108238
Name:MLV DENTAL MEDICAL MANAGEMENT CO. INC.
Entity Type:Organization
Organization Name:MLV DENTAL MEDICAL MANAGEMENT CO. INC.
Other - Org Name:BRIGHT SMILE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-300-7244
Mailing Address - Street 1:10861 SW 156TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1339
Mailing Address - Country:US
Mailing Address - Phone:305-948-0458
Mailing Address - Fax:
Practice Address - Street 1:995 N MIAMI BEACH BLVD
Practice Address - Street 2:SUITE # 100
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3721
Practice Address - Country:US
Practice Address - Phone:305-948-0456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN168121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty