Provider Demographics
NPI:1891475596
Name:BRILLIANT SMILES LAKELAND PA
Entity Type:Organization
Organization Name:BRILLIANT SMILES LAKELAND PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSPREET
Authorized Official - Middle Name:
Authorized Official - Last Name:PARMAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:239-293-9758
Mailing Address - Street 1:320 W HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1543
Mailing Address - Country:US
Mailing Address - Phone:863-644-2428
Mailing Address - Fax:863-644-6235
Practice Address - Street 1:320 W HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1543
Practice Address - Country:US
Practice Address - Phone:863-644-2428
Practice Address - Fax:863-644-6235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty