MEDICARE: BRIGHTEN DENTAL, PLLC

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	1223G0001X	General Practice Dentistry	23719	TX

General Provider Information

NPI Number	:	1497865703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTEN DENTAL, PLLC

Provider Business Mailing Address
First Line	:	1454 CAMPBELL RD.,
Second Line	:	STE 200
City	:	HOUSTON
State	:	TX
Zip	:	77055-4604
Country	:	US
Telephone Number	:	713-722-8400
Fax Number	:	713-722-8441

Provider Business Practice Location Address
First Line	:	1454 CAMPBELL RD.,
Second Line	:	STE 100
City	:	HOUSTON
State	:	TX
Zip	:	77055-4604
Country	:	US
Telephone Number	:	713-722-8400
Fax Number	:	713-461-1152

Authorized Official
Title or Position	:	INSURANCE MANAGER
Name	:	MS. FAYE JAMNEJAD
Credential	:
Telephone Number	:	713-722-8400

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	03/11/2019

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