Organization
BRIGHT SMILES, LLC
Active
Other names
Bright Smiles Orthodontics and Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHUNDA L THOMPSON DDS (OWNER)
(678) 583-8536
Entity
Organization
Contact information
Practice address
907 PAVILION CT, MCDONOUGH, GA 30253-6665
(678) 583-8536
(678) 583-8657
Mailing address
907 PAVILION CT, MCDONOUGH, GA 30253-6665
(678) 583-8536
(678) 583-8657
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN012649
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100486
GA PROVIDER ID
GA
01
—
101869
GA PROVIDER ID
GA
05
—
1235292897
—
GA
01
—
1585058
UNITED CONCORDIA
GA
01
—
9181762
GA PROVIDER NUMBER
GA
01
—
9199332
GA PROVIDER ID
GA
Enumeration date
04/01/2008
Last updated
04/01/2008
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