Provider Demographics
NPI:1770961518
Name:BRIGHT SMILE FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:BRIGHT SMILE FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:ALBRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-879-9761
Mailing Address - Street 1:PO BOX 660845
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35266-0845
Mailing Address - Country:US
Mailing Address - Phone:205-428-7211
Mailing Address - Fax:205-769-9895
Practice Address - Street 1:816 9TH ST N
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020-5314
Practice Address - Country:US
Practice Address - Phone:205-428-7211
Practice Address - Fax:205-769-9895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty