Provider Demographics
NPI:1699869586
Name:ALL BRIGHTDENTAL,P.C.
Entity type:Organization
Organization Name:ALL BRIGHTDENTAL,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRATIX
Authorized Official - Middle Name:KANTILAL
Authorized Official - Last Name:SHROFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-343-3300
Mailing Address - Street 1:26309 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1354
Mailing Address - Country:US
Mailing Address - Phone:718-343-3300
Mailing Address - Fax:718-343-3324
Practice Address - Street 1:26309 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11004-1354
Practice Address - Country:US
Practice Address - Phone:718-343-3300
Practice Address - Fax:718-343-3324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0460881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1881683167Medicaid