Provider Demographics
NPI:1669628236
Name:BRIGHT SMILE DENTAL
Entity Type:Organization
Organization Name:BRIGHT SMILE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LOLLIE
Authorized Official - Middle Name:WESNER
Authorized Official - Last Name:STREIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-637-3636
Mailing Address - Street 1:644 STATESVILLE BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2280
Mailing Address - Country:US
Mailing Address - Phone:704-636-1533
Mailing Address - Fax:
Practice Address - Street 1:644 STATESVILLE BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2280
Practice Address - Country:US
Practice Address - Phone:704-636-1533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty