# BRIGHT SMILE A VISITING DENTAL SERVICE OF NJ LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Visiting Dental Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730587783
- **Authorized official:** BRANDON STATFELD (CEO)
- **Authorized official phone:** (201) 670-0097

## Contact information

- **Practice address:** 1999 CEDAR BRIDGE AVE, STE 3D, LAKEWOOD, NJ 08701
- **Practice address phone:** (201) 670-0097
- **Practice address fax:** (201) 445-0225
- **Mailing address:** 1999 CEDAR BRIDGE AVE, STE 3D, LAKEWOOD, NJ 08701
- **Mailing address phone:** (201) 670-0097
- **Mailing address fax:** (201) 445-0225

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 12/08/2014
- **Last updated:** 11/08/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0448354 | — | NJ |