Provider Demographics
NPI:1275705451
Name:BRIGHT DENTAL
Entity Type:Organization
Organization Name:BRIGHT DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-491-2829
Mailing Address - Street 1:435 WASHINGTON ST
Mailing Address - Street 2:97B
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-4369
Mailing Address - Country:US
Mailing Address - Phone:617-491-2829
Mailing Address - Fax:
Practice Address - Street 1:435 WASHINGTON ST
Practice Address - Street 2:97B
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-4369
Practice Address - Country:US
Practice Address - Phone:617-491-2829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18467122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0167631Medicaid