Provider Demographics
NPI:1508188590
Name:BRIGHT DENTAL LLC
Entity Type:Organization
Organization Name:BRIGHT DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-656-8888
Mailing Address - Street 1:24173 STATE LINE RD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-9999
Mailing Address - Country:US
Mailing Address - Phone:812-656-8888
Mailing Address - Fax:812-656-8016
Practice Address - Street 1:24173 STATE LINE RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-9999
Practice Address - Country:US
Practice Address - Phone:812-656-8888
Practice Address - Fax:812-656-8016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011357A261QD0000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies