Provider Demographics
NPI:1518422880
Name:BRIGHT DENTAL MADISON LLC
Entity Type:Organization
Organization Name:BRIGHT DENTAL MADISON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:S
Authorized Official - Last Name:REHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:224-266-0406
Mailing Address - Street 1:5542 W FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1200
Mailing Address - Country:US
Mailing Address - Phone:224-366-0406
Mailing Address - Fax:
Practice Address - Street 1:7866 MINERAL POINT RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2028
Practice Address - Country:US
Practice Address - Phone:224-366-0406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental