Healthcare Provider Details

I. General information

NPI: 1790799617
Provider Name (Legal Business Name): BRIGHTON DENTAL P.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 WHITMORE LAKE RD SUITE D
BRIGHTON MI
48116-2470
US

IV. Provider business mailing address

5841 WHITMORE LAKE RD. SUITE D
BRIGHTON MI
48116
US

V. Phone/Fax

Practice location:
  • Phone: 810-227-5136
  • Fax: 810-227-5612
Mailing address:
  • Phone: 810-227-5136
  • Fax: 810-227-5612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12544
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10577
License Number StateMI

VIII. Authorized Official

Name: DR. NEIL WAYNE THOMAS
Title or Position: OWNER
Credential: DDS
Phone: 810-227-5136