Healthcare Provider Details

I. General information

NPI: 1669832143
Provider Name (Legal Business Name): BRIGHTER WAY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 W BUCKEYE RD
PHOENIX AZ
85009-5637
US

IV. Provider business mailing address

3140 W BUCKEYE RD
PHOENIX AZ
85009-5637
US

V. Phone/Fax

Practice location:
  • Phone: 602-353-5435
  • Fax: 602-353-5401
Mailing address:
  • Phone: 602-353-5435
  • Fax: 602-353-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KRIS VOLCHECK
Title or Position: EXECUTIVE DIRECTOR
Credential: D.D.S.
Phone: 602-353-5435