Provider Demographics
NPI:1164821906
Name:FRATT DENTAL CORPOARTION
Entity Type:Organization
Organization Name:FRATT DENTAL CORPOARTION
Other - Org Name:BRIGHTNOW DENTAL MORENO VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-428-2000
Mailing Address - Street 1:12761 MORENO BEACH DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-4418
Mailing Address - Country:US
Mailing Address - Phone:951-902-6068
Mailing Address - Fax:651-924-4594
Practice Address - Street 1:12761 MORENO BEACH DR
Practice Address - Street 2:SUITE 103
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-4418
Practice Address - Country:US
Practice Address - Phone:951-902-6068
Practice Address - Fax:651-924-4594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty