Provider Demographics
NPI:1588834014
Name:BRILLIANT SMILES DENTAL, PC
Entity Type:Organization
Organization Name:BRILLIANT SMILES DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HUSSEIN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ABDELWAHAB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-693-9811
Mailing Address - Street 1:820 FLATBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-3102
Mailing Address - Country:US
Mailing Address - Phone:718-693-9811
Mailing Address - Fax:718-693-2577
Practice Address - Street 1:820 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3102
Practice Address - Country:US
Practice Address - Phone:718-693-9811
Practice Address - Fax:718-693-2577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0464461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty