Provider Demographics
NPI:1437938479
Name:BRITEVIEW DENTAL LLC
Entity Type:Organization
Organization Name:BRITEVIEW DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-208-2380
Mailing Address - Street 1:4511 N MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-0309
Mailing Address - Country:US
Mailing Address - Phone:575-208-2380
Mailing Address - Fax:575-218-7537
Practice Address - Street 1:4511 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-0309
Practice Address - Country:US
Practice Address - Phone:575-208-2380
Practice Address - Fax:575-218-7537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty