Provider Demographics
NPI:1659418861
Name:AMERICAN BRITE DENTAL
Entity Type:Organization
Organization Name:AMERICAN BRITE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:FADI
Authorized Official - Middle Name:M
Authorized Official - Last Name:AQEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-884-0108
Mailing Address - Street 1:6636 S PULASKI
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629
Mailing Address - Country:US
Mailing Address - Phone:773-884-0108
Mailing Address - Fax:773-884-0159
Practice Address - Street 1:6636 S PULASKI
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629
Practice Address - Country:US
Practice Address - Phone:773-884-0108
Practice Address - Fax:773-884-0159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty