Healthcare Provider Details

I. General information

NPI: 1356255913
Provider Name (Legal Business Name): BRIGHTWELL DENTAL HYGIENE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 WILSON ST STE 11
BREWER ME
04412-1558
US

IV. Provider business mailing address

PO BOX 322
BREWER ME
04412-0322
US

V. Phone/Fax

Practice location:
  • Phone: 207-573-2127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number StateNULL

VIII. Authorized Official

Name: BARBARA LASKO
Title or Position: OWNER/MEMBER
Credential:
Phone: 207-573-2127