| Brilliant Smile Dental, P.c. | |
|
12720 Se Stark St Portland OR 97233-1539 | |
| (503) 252-6133 | |
| (503) 257-6886 |
| Full Name | Brilliant Smile Dental, P.c. |
|---|---|
| Speciality | Dentist |
| Location | 12720 Se Stark St, Portland, Oregon |
| Authorized Official Name and Position | Nicole Nga Luong (PRESIDENT) |
| Authorized Official Contact | 5037088059 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brilliant Smile Dental, P.c. 12720 Se Stark St Portland OR 97233-1539 Ph: (503) 708-8059 | Brilliant Smile Dental, P.c. 12720 Se Stark St Portland OR 97233-1539 Ph: (503) 252-6133 |
| NPI Number | 1215209861 |
|---|---|
| Provider Enumeration Date | 01/28/2012 |
| Last Update Date | 01/31/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215209861 | NPI | - | NPPES |
| 227117 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D7803 (Oregon) | Primary |
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