Provider Demographics
NPI:1790084549
Name:BRITE SMILE DENTISTRY PC
Entity Type:Organization
Organization Name:BRITE SMILE DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOUSSEIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARAJLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-942-1122
Mailing Address - Street 1:10645 W WARREN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-8009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10645 W WARREN AVE STE 100
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-8009
Practice Address - Country:US
Practice Address - Phone:313-908-1863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010177591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty