| Organization Name: | BRIGHTON DENTAL GROUP LLC |
| NPI Number: | 1013153048 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NOPSARAN CHAIMATTAYOMPOL (DIRECTOR) |
| Mailing Address: | 1607 Commonwealth Ave Suite #3 Brighton |
| State: | MA US |
| Postal Code: | 021354214 |
| Phone Number: | 6177825455 |
| Fax Number: | 6177825452 |
| NPI Enumeration Date: | 12/22/2008 |
| NPI Last Update Date: | 12/22/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0700X |
| License Number: | 20789 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Prosthodontics |
| Taxonomy Definition: | That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. |