Organization
BRILLIANT SMILE DENTAL, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICOLE NGA LUONG DDS (PRESIDENT)
(503) 708-8059
Entity
Organization
Contact information
Practice address
12720 SE STARK ST, PORTLAND, OR 97233-1539
(503) 252-6133
(503) 257-6886
Mailing address
12720 SE STARK ST, PORTLAND, OR 97233-1539
(503) 708-8059
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D7803
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
227117
—
OR
Enumeration date
01/28/2012
Last updated
01/31/2014
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