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General NPI Number Information
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NPI Number | 1194876433
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Entity Type | Organization
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Legal Business Name | BRIGHTON DENTAL PLLC
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 125 WHITE SPRUCE BLVD
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City | ROCHESTER
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State | NY
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Zip | 14623-1607
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Country | US
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Telephone | 585-424-5660
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Fax | 585-424-1239
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Provider Business Mailing Address
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Address Line | 125 WHITE SPRUCE BLVD
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City | ROCHESTER
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State | NY
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Zip | 14623-1607
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Country | US
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Telephone | 585-424-5660
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Fax | 585-424-1239
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YELLAPPA C MRUTHYUNJAYA
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Credential | B.D.S., M.P.H.
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Telephone | 585-424-5660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 032039-1
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License Number State | NY
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