Organization
ISMILE BRIGHT LLC
Active
Organization
ISMILE BRIGHT LLC
Active
Other names
Lightning Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ISIS EL GHANNAM (OWNER)
(786) 716-1589
Entity
Organization
Contact information
Practice address
24795 STATE ROAD 54, LUTZ, FL 33559
(813) 733-0007
Mailing address
8048 PRAISE DR, TAMPA, FL 33625-3744
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
01/02/2024
Last updated
01/24/2025
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