Healthcare Provider Details

I. General information

NPI: 1023205820
Provider Name (Legal Business Name): BRIGHT FOOT CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 W SUNSET AVE SUITE A
SPRINGDALE AR
72762-5136
US

IV. Provider business mailing address

1670 W SUNSET AVE SUITE A
SPRINGDALE AR
72762-5136
US

V. Phone/Fax

Practice location:
  • Phone: 479-750-3131
  • Fax: 479-750-9631
Mailing address:
  • Phone: 479-750-3131
  • Fax: 479-750-9631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number131
License Number StateAR

VIII. Authorized Official

Name: DR. DEAN E BRIGHT
Title or Position: OWNER
Credential: DPM
Phone: 479-750-3131