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General NPI Number Information
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NPI Number | 1215889936
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Entity Type | Organization
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Legal Business Name | BRIGHT SIDE PEDIATRIC DENTISTRY LLC
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Dates
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Enumeration Date | 02/13/2026
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 125 E WATER ST
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City | WEST BEND
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State | WI
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Zip | 53095-3417
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Country | US
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Telephone | 262-310-1819
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Fax | 262-310-1820
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Provider Business Mailing Address
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Address Line | 125 E WATER ST STE 103
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City | WEST BEND
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State | WI
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Zip | 53095-3418
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Country | US
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Telephone | 262-310-1819
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Fax | 262-310-1820
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Authorized Official
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Title or Position | OWNER/PEDIATRIC DENTIST
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Name | DR. LAURA E GOODELL
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Credential | DMD
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Telephone | 262-310-1819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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