Provider Demographics
NPI:1295137552
Name:BRIGHT SMILES DENTAL III, PC
Entity type:Organization
Organization Name:BRIGHT SMILES DENTAL III, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:830-515-4441
Mailing Address - Street 1:2508 N US HIGHWAY 281
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-3984
Mailing Address - Country:US
Mailing Address - Phone:830-515-4441
Mailing Address - Fax:830-515-4443
Practice Address - Street 1:2508 N US HIGHWAY 281
Practice Address - Street 2:SUITE 105
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-3984
Practice Address - Country:US
Practice Address - Phone:830-515-4441
Practice Address - Fax:830-515-4443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX228051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty