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General NPI Number Information
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NPI Number | 1538075668
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Entity Type | Organization
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Legal Business Name | BRIGHTER DENTAL OF SOUTH LOOP
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Dates
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Enumeration Date | 08/19/2026
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Last Update Date | 08/19/2026
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Provider Practice Location Address
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Address Line | 1620 S MICHIGAN AVE #400 STORE FRONT
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City | CHICAGO
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State | IL
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Zip | 60616
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Country | US
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Telephone | 312-888-9902
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Fax |
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Provider Business Mailing Address
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Address Line | 1620 S MICHIGAN AVE #400 STORE FRONT
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City | CHICAGO
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State | IL
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Zip | 60616
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Country | US
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Telephone | 312-888-9902
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ROGER NOUNEH
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Credential | DMD.MS.MBA
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Telephone | 312-927-8882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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