Provider Demographics
NPI:1790371409
Name:CRYSTAL BRIGHT SMILE INC
Entity type:Organization
Organization Name:CRYSTAL BRIGHT SMILE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:DEMIRCHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-352-8200
Mailing Address - Street 1:7738 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2121
Mailing Address - Country:US
Mailing Address - Phone:818-352-8200
Mailing Address - Fax:818-293-3535
Practice Address - Street 1:7738 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2121
Practice Address - Country:US
Practice Address - Phone:818-352-8200
Practice Address - Fax:818-293-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty