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General NPI Number Information
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NPI Number | 1770319535
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Entity Type | Organization
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Legal Business Name | BRIGHT SIDE DENTAL - TRENTON PLLC
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Dates
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Enumeration Date | 09/10/2024
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 3635 WEST RD
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City | TRENTON
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State | MI
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Zip | 48183-2225
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Country | US
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Telephone | 248-971-7365
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Fax |
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Provider Business Mailing Address
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Address Line | 43380 WOODWARD AVE STE 105
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-5050
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CONTROLLER
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Name | KELLY TREMONTI
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Credential |
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Telephone | 248-971-7365
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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 |
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License Number State |
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