Provider Demographics
NPI:1447658844
Name:BRIGHTWATER DENTAL CARE PC
Entity type:Organization
Organization Name:BRIGHTWATER DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTALLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-647-4994
Mailing Address - Street 1:200 HOWELLS RD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-5351
Mailing Address - Country:US
Mailing Address - Phone:631-647-4994
Mailing Address - Fax:
Practice Address - Street 1:200 HOWELLS RD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5351
Practice Address - Country:US
Practice Address - Phone:631-647-4994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty