Provider Demographics
NPI:1265990980
Name:BRIGHTWORK DENTAL CARE PA
Entity type:Organization
Organization Name:BRIGHTWORK DENTAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAULIEU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-443-6255
Mailing Address - Street 1:130 CENTRE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-2598
Mailing Address - Country:US
Mailing Address - Phone:207-443-6255
Mailing Address - Fax:
Practice Address - Street 1:130 CENTRE ST STE 2
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2598
Practice Address - Country:US
Practice Address - Phone:207-443-6255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty