Provider Demographics
NPI:1245620350
Name:BRIGHT SIDE SLEEP SOLUTIONS, PLLC
Entity Type:Organization
Organization Name:BRIGHT SIDE SLEEP SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:T
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-882-2070
Mailing Address - Street 1:43368 WOODWARD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5051
Mailing Address - Country:US
Mailing Address - Phone:248-971-7366
Mailing Address - Fax:248-971-7439
Practice Address - Street 1:43368 WOODWARD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5051
Practice Address - Country:US
Practice Address - Phone:248-971-7366
Practice Address - Fax:248-971-7439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011555122300000X, 332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H73019OtherALLIED DME PTAN
MI1548283781OtherINDIVIDUAL NPI FOR RANDY T. FISHMAN, D.D.S.
MI7387260001Medicare NSC
MIMI8739Medicare PIN