NPIMap

Organization Active NPI

Bright Smiles, P.a.

  • Dental Clinic/Center
  • Baltimore, MD
National Provider Identifier
1205013554
Registry record updated Nov 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
11814 Issued in MD
Legal business name
BRIGHT SMILES, P.A.
Practice address
4115 Wilkens Ave Ste 101
Baltimore, MD 21229-4750
Phone
(410) 737-9666
Fax
(410) 737-9667
NPI assigned
Jan 29, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Shankari Kumarachandran, D.D.S.
Title
President
Phone
(410) 737-9666

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 11814 MD Primary

Addresses

Primary practice location

4115 Wilkens Ave Ste 101
Baltimore, MD 21229-4750

Mailing address

4115 Wilkens Ave Ste 101
Baltimore, MD 21229-4750
Phone (410) 737-9666

Other identifiers 1

IdentifierTypeStateIssuer
404887300MedicaidMD

National Provider Directory

National Provider Directory

Locations

4115 Wilkens Ave
Ste 101
Baltimore, MD 21229
Phone (410) 737-9666

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415836800000",
    "number": "1205013554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4115 WILKENS AVE STE 101",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212294750",
            "telephone_number": "410-737-9666",
            "fax_number": "410-737-9667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4115 WILKENS AVE STE 101",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212294750",
            "telephone_number": "410-737-9666",
            "fax_number": "410-737-9667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIGHT SMILES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-29",
        "last_updated": "2014-11-13",
        "status": "A",
        "authorized_official_last_name": "KUMARACHANDRAN",
        "authorized_official_first_name": "SHANKARI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-737-9666",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MD",
            "license": "11814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "404887300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.