Provider Demographics
NPI:1932243284
Name:BRIGHTON, DIANE (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:BRIGHTON
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W FAIRHAVEN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-1062
Mailing Address - Country:US
Mailing Address - Phone:360-757-3636
Mailing Address - Fax:360-757-1132
Practice Address - Street 1:205 W FAIRHAVEN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-1062
Practice Address - Country:US
Practice Address - Phone:360-757-3636
Practice Address - Fax:360-757-1132
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA64541223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
911087450OtherTAX ID NUMBER