Organization
BRIGHT SMILE DENTURE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN D. PHILLIPS (OFFICE ADMINISTRATOR)
(313) 416-2085
Entity
Organization
Contact information
Practice address
5026 BEDFORD ST, DETROIT, MI 48224-2649
(313) 416-2085
(248) 478-0239
Mailing address
5026 BEDFORD ST, DETROIT, MI 48224-2649
(313) 416-2085
(248) 478-0239
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4821853
—
MI
Enumeration date
11/13/2006
Last updated
10/17/2007
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