NPI Code Detail JSON Logo

1083569396 NPI number — BRIGHTSIDE ORAL SURGERY LLC

NPI Number: 1083569396
Health Care Provider/Practitioner: BRIGHTSIDE ORAL SURGERY LLC

Information about “1083569396” NPI (BRIGHTSIDE ORAL SURGERY LLC) exists in 1083569396 in HTML format HTML  |  1083569396 in plain Text format TXT  |  1083569396 in PDF (Portable Document Format) PDF  |  1083569396 in an XML format XML  formats.

NPI Number : 1083569396 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1083569396",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BRIGHTSIDE ORAL SURGERY LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5682 S 3500 W UNIT A",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROY",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84067-9108",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "801-773-9828",
    "MailingAddressFaxNumber": "801-773-9828",
    "FirstLinePracticeLocationAddress": "5682 S 3500 W UNIT A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROY",
    "PracticeLocationAddressStateName": "UT",
    "PracticeLocationAddressPostalCode": "84067-9108",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "801-773-9828",
    "PracticeLocationAddressFaxNumber": "801-773-9828",
    "EnumerationDate": "03/02/2026",
    "LastUpdateDate": "03/02/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GONZALES",
    "AuthorizedOfficialFirstName": "EBONIE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CREDENTIALING MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "505-850-3769",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "204E00000X",
        "TaxonomyName": "Oral & Maxillofacial Surgery (D.M.D.)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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