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General NPI Number Information
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NPI Number | 1437938479
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Entity Type | Organization
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Legal Business Name | BRITEVIEW DENTAL LLC
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Dates
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Enumeration Date | 09/28/2023
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 4511 N MAIN ST STE B
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City | ROSWELL
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State | NM
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Zip | 88201-0309
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Country | US
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Telephone | 575-208-2380
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Fax | 575-218-7537
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Provider Business Mailing Address
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Address Line | 4511 N MAIN ST STE B
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City | ROSWELL
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State | NM
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Zip | 88201-0309
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Country | US
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Telephone | 575-208-2380
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Fax | 575-218-7537
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Authorized Official
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Title or Position | ASSISTANT MANAGER
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Name | ALEXIS DE LEON
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Credential |
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Telephone | 575-208-2380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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