Provider Demographics
NPI:1043869050
Name:BRIGHAM AND BRIGHAM SLEEP CARE
Entity Type:Organization
Organization Name:BRIGHAM AND BRIGHAM SLEEP CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-742-9852
Mailing Address - Street 1:2281 BENTON RD
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3403
Mailing Address - Country:US
Mailing Address - Phone:318-742-9852
Mailing Address - Fax:318-742-2288
Practice Address - Street 1:2281 BENTON RD
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3403
Practice Address - Country:US
Practice Address - Phone:318-742-9852
Practice Address - Fax:318-742-2288
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIGHAM AND BRIGHAM A PROFESSIONAL DENTAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty