Provider Demographics
NPI:1063786507
Name:BRIGHT DENTAL AT BRIDGEPORT, PC
Entity type:Organization
Organization Name:BRIGHT DENTAL AT BRIDGEPORT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANGANAYAKI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIRUMAMILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-336-9767
Mailing Address - Street 1:4575 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1818
Mailing Address - Country:US
Mailing Address - Phone:203-371-6700
Mailing Address - Fax:
Practice Address - Street 1:4575 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1818
Practice Address - Country:US
Practice Address - Phone:203-371-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0103971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty