Organization · NPI-2

1st Brite Dental

Dentist, General Practice · Chicago, IL

NPI number1487791422
StatusActive
Last updated in NPPESAug 22, 2020

Details

NPI
1487791422
Entity type
Organization (NPI-2)
Legal business name
1st Brite Dental
Organization subpart
No
Enumeration date
Jan 31, 2007
Last updated
Aug 22, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice019026128ILYes

Practice location

2759 W 55th St
Chicago, IL 60632

Phone 773-776-5277 · Fax 773-776-5278

Mailing address

2759 W 55th St
Chicago, IL 60632

Phone 773-776-5277 · Fax 773-776-5278

Authorized official

Fadi M Aqel
Dentist
7737765277

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