Provider Demographics
NPI:1255360632
Name:BRIGHT, CAROL LYNN (RDH)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LYNN
Last Name:BRIGHT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 W DREXEL AVE
Mailing Address - Street 2:#208
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9356
Mailing Address - Country:US
Mailing Address - Phone:414-550-1720
Mailing Address - Fax:
Practice Address - Street 1:1135 SOUTH CESAR CHAVEZ DRIVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204
Practice Address - Country:US
Practice Address - Phone:414-645-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5161016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist