Provider Demographics
NPI:1750660304
Name:BRIGHT SMILE CENTER CLEVELAND COURT
Entity Type:Organization
Organization Name:BRIGHT SMILE CENTER CLEVELAND COURT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:CHARAE
Authorized Official - Last Name:HANCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-271-1220
Mailing Address - Street 1:5C CLEVELAND CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2414
Mailing Address - Country:US
Mailing Address - Phone:864-271-1220
Mailing Address - Fax:864-271-7267
Practice Address - Street 1:5C CLEVELAND CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2414
Practice Address - Country:US
Practice Address - Phone:864-271-1220
Practice Address - Fax:864-271-7267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3714122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty