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General NPI Number Information
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NPI Number | 1194148387
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Entity Type | Organization
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Legal Business Name | BRITE SMILE CENTER, PC
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Dates
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Enumeration Date | 01/24/2014
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Last Update Date | 01/24/2014
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Provider Practice Location Address
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Address Line | 33020 PALMER RD
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City | WESTLAND
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State | MI
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Zip | 48186-5519
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Country | US
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Telephone | 734-728-6900
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Fax | 734-728-6901
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Provider Business Mailing Address
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Address Line | 33020 PALMER RD
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City | WESTLAND
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State | MI
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Zip | 48186-5519
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Country | US
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Telephone | 734-728-6900
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Fax | 734-728-6901
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Authorized Official
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Title or Position | OWNER/ PRESIDEN
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Name | DR. HAYTHAM A FARES
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Credential | DDS
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Telephone | 734-728-6900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17022
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License Number State | MI
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