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Organization

BRIGHT SMILE FAMILY DENTAL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GEHAN ADAM (DDS)
(708) 293-1903
Entity
Organization

Contact information

Practice address
12601 WESTERN AVE, UNIT B, BLUE ISLAND, IL 60406-1749
(708) 293-1903
Mailing address
12601 WESTERN AVE, UNIT B, BLUE ISLAND, IL 60406-1749

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019027109
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1972566305
IL
Enumeration date
02/28/2017
Last updated
02/28/2017
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