Provider Demographics
NPI:1932934932
Name:BRIGHT SMILES COMMUNITY CLINIC & DENTAL
Entity type:Organization
Organization Name:BRIGHT SMILES COMMUNITY CLINIC & DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MAHADO
Authorized Official - Middle Name:
Authorized Official - Last Name:ONWUKWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-910-1131
Mailing Address - Street 1:334 E LAKE ST STE 104
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2485
Mailing Address - Country:US
Mailing Address - Phone:612-910-1131
Mailing Address - Fax:
Practice Address - Street 1:334 E LAKE ST STE 104
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2485
Practice Address - Country:US
Practice Address - Phone:612-910-1131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WANLAINJO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-09
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center