Provider Demographics
NPI:1194148387
Name:BRITE SMILE CENTER, PC
Entity type:Organization
Organization Name:BRITE SMILE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDEN
Authorized Official - Prefix:DR
Authorized Official - First Name:HAYTHAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-728-6900
Mailing Address - Street 1:33020 PALMER RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-5519
Mailing Address - Country:US
Mailing Address - Phone:734-728-6900
Mailing Address - Fax:734-728-6901
Practice Address - Street 1:33020 PALMER RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5519
Practice Address - Country:US
Practice Address - Phone:734-728-6900
Practice Address - Fax:734-728-6901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI170221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty