Provider Demographics
NPI:1700130374
Name:BRITE DENTAL BELMONT, P.C.
Entity Type:Organization
Organization Name:BRITE DENTAL BELMONT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:708-439-4655
Mailing Address - Street 1:4849 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-4330
Mailing Address - Country:US
Mailing Address - Phone:773-930-4943
Mailing Address - Fax:773-930-4946
Practice Address - Street 1:4849 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-4330
Practice Address - Country:US
Practice Address - Phone:773-930-4943
Practice Address - Fax:773-930-4946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty