Provider Demographics
NPI:1629629720
Name:BRIGHTMAN DENTAL
Entity Type:Organization
Organization Name:BRIGHTMAN DENTAL
Other - Org Name:PETER BRIGHTMAN DMD, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRIGHTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:951-735-5588
Mailing Address - Street 1:2083 COMPTON AVE
Mailing Address - Street 2:#204
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881
Mailing Address - Country:US
Mailing Address - Phone:951-735-5588
Mailing Address - Fax:951-735-2968
Practice Address - Street 1:2083 COMPTON AVE
Practice Address - Street 2:#204
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881
Practice Address - Country:US
Practice Address - Phone:951-735-5588
Practice Address - Fax:951-735-2968
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETER S. BRIGHTMAN, DMD, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-20
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty