1316223662 NPI number — BRIGHTON MODERN DENTISTRY AND ORTHODONTICS, LLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316223662 NPI number — BRIGHTON MODERN DENTISTRY AND ORTHODONTICS, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIGHTON MODERN DENTISTRY AND ORTHODONTICS, LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316223662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2860 MICHELLE DRIVE 2ND FLOOR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-368-2077
Provider Business Mailing Address Fax Number:
714-368-2092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3494 EAGLE BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-659-3003
Provider Business Practice Location Address Fax Number:
303-659-3033
Provider Enumeration Date:
11/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
RODGERS
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER DOCTOR
Authorized Official Telephone Number:
303-659-3003

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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