Provider Demographics
NPI:1790160844
Name:BRIGHT SMILE LLC
Entity Type:Organization
Organization Name:BRIGHT SMILE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO /PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMAHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-394-5100
Mailing Address - Street 1:1605 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1209
Mailing Address - Country:US
Mailing Address - Phone:708-394-5100
Mailing Address - Fax:
Practice Address - Street 1:1605 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1209
Practice Address - Country:US
Practice Address - Phone:708-394-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization