Provider Demographics
NPI:1538327572
Name:BRIGHTER IMAGE DENTAL
Entity Type:Organization
Organization Name:BRIGHTER IMAGE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-361-6900
Mailing Address - Street 1:1031 AVENIDA PICO STE 203
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6356
Mailing Address - Country:US
Mailing Address - Phone:949-361-6900
Mailing Address - Fax:949-361-3779
Practice Address - Street 1:1031 AVENIDA PICO
Practice Address - Street 2:#203
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6352
Practice Address - Country:US
Practice Address - Phone:949-361-6900
Practice Address - Fax:949-361-3779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48051261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental