Provider Demographics
NPI:1831286525
Name:BRIGHTER SMILES FAMILY DENTAL
Entity Type:Organization
Organization Name:BRIGHTER SMILES FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:
Authorized Official - First Name:TYNA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:DIEROLF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-599-2590
Mailing Address - Street 1:41 KLEIN AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7178
Mailing Address - Country:US
Mailing Address - Phone:717-274-5613
Mailing Address - Fax:717-274-9427
Practice Address - Street 1:41 KLEIN AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7178
Practice Address - Country:US
Practice Address - Phone:717-274-5613
Practice Address - Fax:717-274-9427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty