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General NPI Number Information
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NPI Number | 1588058903
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Entity Type | Organization
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Legal Business Name | BRIGHTON DENTAL,LLC
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 04/17/2015
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Provider Practice Location Address
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Address Line | 1257 N FRASER ST
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City | GEORGETOWN
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State | SC
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Zip | 29440-4086
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Country | US
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Telephone | 843-527-1373
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Fax | 843-527-7553
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Provider Business Mailing Address
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Address Line | P.O. BOX 2550
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City | MURRELLS INLET
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State | SC
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Zip | 29576
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Country | US
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Telephone | 843-527-1373
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Fax | 843-527-7553
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Authorized Official
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Title or Position | OWNER
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Name | MISS CORNELIA JANNA BECK
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Credential |
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Telephone | 843-237-3525
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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 | 2222
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License Number State | SC
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