Provider Demographics
NPI:1194055483
Name:BRILLIANT SMILES DENTAL GROUP - LANSDOWNE LLC
Entity type:Organization
Organization Name:BRILLIANT SMILES DENTAL GROUP - LANSDOWNE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:AITKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-626-5080
Mailing Address - Street 1:321 N LANSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1017
Mailing Address - Country:US
Mailing Address - Phone:610-626-5080
Mailing Address - Fax:
Practice Address - Street 1:321 N LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-1017
Practice Address - Country:US
Practice Address - Phone:610-626-5080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0359661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty