Bright Smile Family Dental

Primary specialty

DentistTaxonomy code 122300000X

License

019027109 Issued in IL

Legal business name

BRIGHT SMILE FAMILY DENTAL

Practice address

12601 Western Ave
Unit B
Blue Island, IL 60406-1749

Phone

(708) 293-1903

NPI assigned

Feb 28, 2017

Last updated

Feb 28, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gehan Adam

Title

DDS

Phone

(708) 293-1903

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1488240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488240000000",
    "number": "1376083006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12601 WESTERN AVE",
            "address_2": "UNIT B",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604061749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12601 WESTERN AVE",
            "address_2": "UNIT B",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604061749",
            "telephone_number": "708-293-1903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIGHT SMILE FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-28",
        "last_updated": "2017-02-28",
        "status": "A",
        "authorized_official_last_name": "ADAM",
        "authorized_official_first_name": "GEHAN",
        "authorized_official_title_or_position": "DDS",
        "authorized_official_telephone_number": "708-293-1903"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019027109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1972566305",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laquay Boone
• Daniel Allen Boston, PHARMD
• Andrea R. Boyd, MA, QMHP
• James Branch
• Ann Brekke, LCPC
• Bright Smile Family Dental
• Rita Brongiel, RD, LDN
• Melissa R Brousil, BA, MAOL
• Gina Brown
• Frank M Bucki Jr., D.C.

• Dentist in Blue Island, IL
• Providers in Blue Island, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; 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.