Provider Demographics
NPI:1417300765
Name:BRIGHT SIDE DENTAL TROY
Entity Type:Organization
Organization Name:BRIGHT SIDE DENTAL TROY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PEATRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SABBAGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-971-7435
Mailing Address - Street 1:1777 AXTELL DR
Mailing Address - Street 2:STE. 207
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4404
Mailing Address - Country:US
Mailing Address - Phone:248-649-3116
Mailing Address - Fax:248-649-6768
Practice Address - Street 1:1777 AXTELL DR
Practice Address - Street 2:STE. 207
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4404
Practice Address - Country:US
Practice Address - Phone:248-649-3116
Practice Address - Fax:248-649-6768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty