Healthcare Provider Details

I. General information

NPI: 1538075668
Provider Name (Legal Business Name): BRIGHTER DENTAL OF SOUTH LOOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 S MICHIGAN AVE #400 STORE FRONT
CHICAGO IL
60616
US

IV. Provider business mailing address

1620 S MICHIGAN AVE #400 STORE FRONT
CHICAGO IL
60616
US

V. Phone/Fax

Practice location:
  • Phone: 312-888-9902
  • Fax:
Mailing address:
  • Phone: 312-888-9902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: ROGER NOUNEH
Title or Position: MANAGING MEMBER
Credential: DMD.MS.MBA
Phone: 312-927-8882