Provider Demographics
NPI:1417322637
Name:BRILLIANT DENTAL CARE
Entity Type:Organization
Organization Name:BRILLIANT DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-839-0900
Mailing Address - Street 1:4000 WASHINGTON AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-5673
Mailing Address - Country:US
Mailing Address - Phone:713-839-0900
Mailing Address - Fax:
Practice Address - Street 1:4000 WASHINGTON AVE
Practice Address - Street 2:STE 201
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-5673
Practice Address - Country:US
Practice Address - Phone:713-839-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19679261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental