Provider Demographics
NPI:1629380605
Name:BRIGHT SMILES DENTAL PC
Entity Type:Organization
Organization Name:BRIGHT SMILES DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-989-3200
Mailing Address - Street 1:1912 W PECAN ST
Mailing Address - Street 2:STE A103
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3561
Mailing Address - Country:US
Mailing Address - Phone:512-989-3200
Mailing Address - Fax:512-989-3201
Practice Address - Street 1:1912 W PECAN ST
Practice Address - Street 2:STE A103
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3561
Practice Address - Country:US
Practice Address - Phone:512-989-3200
Practice Address - Fax:512-989-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-07
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX228051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty