Healthcare Provider Details

I. General information

NPI: 1598720278
Provider Name (Legal Business Name): BRIGHTON FAMILY DENTAL GROUP LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WARREN STREET
BRIGHTON MA
02135-3601
US

IV. Provider business mailing address

77 WARREN STREET
BRIGHTON MA
02135-3601
US

V. Phone/Fax

Practice location:
  • Phone: 617-562-5210
  • Fax: 617-782-5049
Mailing address:
  • Phone: 617-562-5210
  • Fax: 617-782-5049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16920
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number14635
License Number StateMA

VIII. Authorized Official

Name: MR. THOMAS MICHAEL VILLANI
Title or Position: OWNER
Credential: DMD
Phone: 617-562-5212