Provider Demographics
NPI:1316613607
Name:BRIGHTSIDE DENTAL, LLC
Entity type:Organization
Organization Name:BRIGHTSIDE DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-596-8085
Mailing Address - Street 1:7900 COLLEGE BLVD STE 131
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2194
Mailing Address - Country:US
Mailing Address - Phone:970-596-8085
Mailing Address - Fax:
Practice Address - Street 1:4731 S COCHISE DR STE 110
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6975
Practice Address - Country:US
Practice Address - Phone:970-901-9865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental