Provider Demographics
NPI:1902174162
Name:BRIGHTON DENTAL CARE
Entity Type:Organization
Organization Name:BRIGHTON DENTAL CARE
Other - Org Name:BRIGHTON DENTAL CARE PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAFID
Authorized Official - Middle Name:
Authorized Official - Last Name:KIZY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:248-593-5300
Mailing Address - Street 1:2583 S ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4442
Mailing Address - Country:US
Mailing Address - Phone:248-293-5300
Mailing Address - Fax:248-293-5303
Practice Address - Street 1:2583 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4442
Practice Address - Country:US
Practice Address - Phone:248-293-5300
Practice Address - Fax:248-293-5303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1823026122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty