MEDICARE: BRIGHT DENTAL MADISON EAST LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1245808260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT DENTAL MADISON EAST LLC

Provider Business Mailing Address
First Line	:	1853 NORTHPORT DR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-3027
Country	:	US
Telephone Number	:	608-716-5946
Fax Number	:

Provider Business Practice Location Address
First Line	:	1853 NORTHPORT DR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-3027
Country	:	US
Telephone Number	:	608-716-5946
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SYED REHMAN
Credential	:	DMD
Telephone Number	:	608-716-5946

Provider Enumeration Date	:	06/15/2021
Last Update Date	:	06/15/2021

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Directions to “BRIGHT DENTAL MADISON EAST LLC ” Practice Location

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