Organization
BRIGHTER DENTAL OF OLD TOWN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER NOUNEH (MANAGING MEMBER)
(312) 337-3300
Entity
Organization
Contact information
Practice address
1254 N WELLS ST, CHICAGO, IL 60610-1981
(312) 337-3300
Mailing address
1254 N WELLS ST, CHICAGO, IL 60610-1981
(312) 337-3300
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019025485
IL
122300000X
Dentist
019029031
IL
122300000X
Dentist
019029061
IL
122300000X
Dentist
019029429
IL
122300000X
Dentist
019029936
IL
1223P0300X
Periodontics
021001990
IL
Other
Enumeration date
11/20/2014
Last updated
11/20/2014
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