1437580818 NPI number — BRITE SMILES DENTAL CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437580818 NPI number — BRITE SMILES DENTAL CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRITE SMILES DENTAL CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437580818
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8977 HUNTERS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APPLE VALLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55124-9486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-891-8484
Provider Business Mailing Address Fax Number:
952-891-1256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8977 HUNTERS WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55124-9486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-891-8484
Provider Business Practice Location Address Fax Number:
952-891-1256
Provider Enumeration Date:
12/10/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GUNTER
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCIAL ADMINISTRATOR
Authorized Official Telephone Number:
952-891-8484

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  8270 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)