Healthcare Provider Details

I. General information

NPI: 1437938479
Provider Name (Legal Business Name): BRITEVIEW DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4511 N MAIN ST STE B
ROSWELL NM
88201-0309
US

IV. Provider business mailing address

4511 N MAIN ST STE B
ROSWELL NM
88201-0309
US

V. Phone/Fax

Practice location:
  • Phone: 575-208-2380
  • Fax: 575-218-7537
Mailing address:
  • Phone: 575-208-2380
  • Fax: 575-218-7537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEXIS DE LEON
Title or Position: ASSISTANT MANAGER
Credential:
Phone: 575-208-2380