Provider Demographics
NPI:1134446370
Name:BRITE DENTAL MINNESOTA P.C.
Entity type:Organization
Organization Name:BRITE DENTAL MINNESOTA P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:FADI
Authorized Official - Middle Name:M
Authorized Official - Last Name:AGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-439-4655
Mailing Address - Street 1:334 EAST LAKE ST.
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408
Mailing Address - Country:US
Mailing Address - Phone:708-439-4655
Mailing Address - Fax:
Practice Address - Street 1:334 EAST LAKE ST.
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408
Practice Address - Country:US
Practice Address - Phone:708-439-4655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND125011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty