Provider Demographics
NPI:1033919881
Name:BRIGHTWHITES DENTAL PLLC
Entity type:Organization
Organization Name:BRIGHTWHITES DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAYTH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GHANIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-799-2614
Mailing Address - Street 1:6214 OLD FRANCONIA RD STE A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3400
Mailing Address - Country:US
Mailing Address - Phone:703-719-6158
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:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty