# BRIGHT DENTAL STUDIO PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184340622
- **Authorized official:** SIDNEY J FOWLER DDS (OWNER)
- **Authorized official phone:** (936) 564-9401

## Contact information

- **Practice address:** 120 W COLUMBIA ST, SAN AUGUSTINE, TX 75972-1904
- **Practice address phone:** (936) 288-3520
- **Practice address fax:** (936) 288-5076
- **Mailing address:** 120 W COLUMBIA ST, SAN AUGUSTINE, TX 75972-1904
- **Mailing address phone:** (936) 288-3520
- **Mailing address fax:** (936) 288-5076

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |
| 261QS0112X | Oral and Maxillofacial Surgery Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 10/17/2022
- **Last updated:** 10/31/2022