Provider Demographics
NPI:1871023507
Name:BRIGHTWHITES, P.C.
Entity Type:Organization
Organization Name:BRIGHTWHITES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIGITTE
Authorized Official - Middle Name:WHITE
Authorized Official - Last Name:ZIVKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-719-6158
Mailing Address - Street 1:6101 CALICO POOL LN
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3704
Mailing Address - Country:US
Mailing Address - Phone:703-508-2188
Mailing Address - Fax:
Practice Address - Street 1:6214 OLD FRANCONIA RD STE A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3400
Practice Address - Country:US
Practice Address - Phone:703-719-6158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412187261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1205026283OtherGENERAL DENTIST