Provider Demographics
NPI:1629526223
Name:BRIGHT ORTHODONTICS
Entity Type:Organization
Organization Name:BRIGHT ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:VEIT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-267-3045
Mailing Address - Street 1:4567 BELLHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-9338
Mailing Address - Country:US
Mailing Address - Phone:920-267-3045
Mailing Address - Fax:
Practice Address - Street 1:1850 W POINTE DR
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-4164
Practice Address - Country:US
Practice Address - Phone:920-233-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001179151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty