Provider Demographics
NPI:1659644086
Name:BRITE DENTAL CENTER INC.
Entity Type:Organization
Organization Name:BRITE DENTAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHARLOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-872-9696
Mailing Address - Street 1:15002 ELLA BLVD
Mailing Address - Street 2:SUITE 42
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-5621
Mailing Address - Country:US
Mailing Address - Phone:281-872-9696
Mailing Address - Fax:281-872-9699
Practice Address - Street 1:15002 ELLA BLVD
Practice Address - Street 2:SUITE 42
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-5621
Practice Address - Country:US
Practice Address - Phone:281-872-9696
Practice Address - Fax:281-872-9699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135076110Medicaid