Healthcare Provider Details

I. General information

NPI: 1316558794
Provider Name (Legal Business Name): BRIGHTER DENTAL OF NJ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 SHOPPES BLVD SHOPPES AT NORTH BRUNSWICK
NORTH BRUNSWICK NJ
08902
US

IV. Provider business mailing address

320 S MAIN ST FL 2
PHILLIPSBURG NJ
08865-2859
US

V. Phone/Fax

Practice location:
  • Phone: 732-258-8700
  • Fax:
Mailing address:
  • Phone: 908-386-2443
  • Fax: 908-387-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JAY RANA
Title or Position: DIRECTOR OF INSURANCE
Credential:
Phone: 908-387-8322