Healthcare Provider Details

I. General information

NPI: 1659433001
Provider Name (Legal Business Name): CHARLES JONATHAN BRIGHT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1178 SHEPHERDSTOWN RD
MARTINSBURG WV
25404
US

IV. Provider business mailing address

PO BOX 2016
MARTINSBURG WV
25402
US

V. Phone/Fax

Practice location:
  • Phone: 304-267-7815
  • Fax:
Mailing address:
  • Phone: 304-267-7815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2203
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5888
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: