Provider Demographics
NPI:1285193334
Name:BRIGHTER DENTAL, IMPLANT PC.
Entity Type:Organization
Organization Name:BRIGHTER DENTAL, IMPLANT PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:GHADAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-231-5566
Mailing Address - Street 1:820 SUFFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4498
Mailing Address - Country:US
Mailing Address - Phone:631-231-5566
Mailing Address - Fax:631-231-0561
Practice Address - Street 1:820 SUFFOLK AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4498
Practice Address - Country:US
Practice Address - Phone:631-231-5566
Practice Address - Fax:631-231-0561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental