Provider Demographics
NPI:1487921466
Name:BRIGHT SMILE DENTAL CARE, PSC
Entity type:Organization
Organization Name:BRIGHT SMILE DENTAL CARE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ABUROB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-734-1967
Mailing Address - Street 1:60 STONECREST CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8155
Mailing Address - Country:US
Mailing Address - Phone:502-633-1819
Mailing Address - Fax:502-633-1817
Practice Address - Street 1:60 STONECREST CT
Practice Address - Street 2:SUITE 200
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8157
Practice Address - Country:US
Practice Address - Phone:502-633-1819
Practice Address - Fax:502-633-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-19
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8387122300000X
KY9059122300000X
KY8112122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100051530Medicaid