Provider Demographics
NPI:1841598257
Name:A BRIGHT SMILE 4 KIDS, LLC
Entity Type:Organization
Organization Name:A BRIGHT SMILE 4 KIDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-927-3000
Mailing Address - Street 1:3606 S ZARZAMORA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78225-1359
Mailing Address - Country:US
Mailing Address - Phone:210-927-3000
Mailing Address - Fax:210-332-5190
Practice Address - Street 1:3606 S ZARZAMORA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78225-1359
Practice Address - Country:US
Practice Address - Phone:210-927-3000
Practice Address - Fax:210-332-5190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1184786147Medicaid