Provider Demographics
NPI:1689928830
Name:BRIGHT SMILES DENTAL LLC
Entity Type:Organization
Organization Name:BRIGHT SMILES DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOREHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-349-3569
Mailing Address - Street 1:8301 BRIARWOOD ST
Mailing Address - Street 2:SUITE #202
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-3333
Mailing Address - Country:US
Mailing Address - Phone:907-359-3569
Mailing Address - Fax:907-349-8213
Practice Address - Street 1:8301 BRIARWOOD ST
Practice Address - Street 2:SUITE #202
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-3333
Practice Address - Country:US
Practice Address - Phone:907-359-3569
Practice Address - Fax:907-349-8213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK0979122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty