Provider Demographics
NPI:1104615053
Name:BOSTON BRIGHTSMILE LLC
Entity type:Organization
Organization Name:BOSTON BRIGHTSMILE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:YING
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:857-361-2023
Mailing Address - Street 1:14 MARION ST APT 24
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4430
Mailing Address - Country:US
Mailing Address - Phone:857-361-2023
Mailing Address - Fax:
Practice Address - Street 1:15 W WATER ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-2926
Practice Address - Country:US
Practice Address - Phone:857-361-2023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOSTON BRIGHTSMILE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental