Provider Demographics
NPI:1194876433
Name:BRIGHTON DENTAL PLLC
Entity type:Organization
Organization Name:BRIGHTON DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YELLAPPA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MRUTHYUNJAYA
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, MPH
Authorized Official - Phone:585-424-5660
Mailing Address - Street 1:125 WHITE SPRUCE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1607
Mailing Address - Country:US
Mailing Address - Phone:585-424-5660
Mailing Address - Fax:585-424-1239
Practice Address - Street 1:125 WHITE SPRUCE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1607
Practice Address - Country:US
Practice Address - Phone:585-424-5660
Practice Address - Fax:585-424-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032039-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty