MEDICARE: BRIGHTON DENTAL CARE

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	122300000X	Dentist	L1823026	MI

General Provider Information

NPI Number	:	1902174162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTON DENTAL CARE

Provider Business Mailing Address
First Line	:	2583 S ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-4442
Country	:	US
Telephone Number	:	248-293-5300
Fax Number	:	248-293-5303

Provider Business Practice Location Address
First Line	:	2583 S ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-4442
Country	:	US
Telephone Number	:	248-293-5300
Fax Number	:	248-293-5303

Authorized Official
Title or Position	:	OWNER
Name	:	WAFID KIZY
Credential	:	DMD
Telephone Number	:	248-593-5300

Provider Enumeration Date	:	12/02/2011
Last Update Date	:	12/02/2011

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Directions to “BRIGHTON DENTAL CARE ” Practice Location

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