Provider Demographics
NPI:1881922953
Name:BRITE SMILES INC.
Entity type:Organization
Organization Name:BRITE SMILES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENAE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:BLOME
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:507-475-0628
Mailing Address - Street 1:4366 270TH ST E
Mailing Address - Street 2:PO BOX 237
Mailing Address - City:MEDFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55049-8001
Mailing Address - Country:US
Mailing Address - Phone:507-475-0628
Mailing Address - Fax:507-446-1098
Practice Address - Street 1:320 3RD ST NW
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5195
Practice Address - Country:US
Practice Address - Phone:507-475-0628
Practice Address - Fax:507-446-1098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH6616124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty