Provider Demographics
NPI:1366279622
Name:DANBURY BRIGHT SMILES LLC
Entity type:Organization
Organization Name:DANBURY BRIGHT SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ANUSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:475-529-5893
Mailing Address - Street 1:122 TOWER RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-3653
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:57 NORTH ST STE 411
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5629
Practice Address - Country:US
Practice Address - Phone:475-529-5893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty