Provider Demographics
NPI:1710321930
Name:BRITE DENTAL WEST ST PAUL PC
Entity Type:Organization
Organization Name:BRITE DENTAL WEST ST PAUL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
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 1:1200 ROBERT ST S
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEST ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-2308
Mailing Address - Country:US
Mailing Address - Phone:651-340-9151
Mailing Address - Fax:651-340-9152
Practice Address - Street 1:1200 ROBERT ST S
Practice Address - Street 2:SUITE C
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-2308
Practice Address - Country:US
Practice Address - Phone:651-340-9151
Practice Address - Fax:651-340-9152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12501122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty