Provider Demographics
NPI:1598993610
Name:BRILLIANT DENTAL, PC
Entity Type:Organization
Organization Name:BRILLIANT DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:YEH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:917-660-3685
Mailing Address - Street 1:837 58TH ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3662
Mailing Address - Country:US
Mailing Address - Phone:718-686-9888
Mailing Address - Fax:718-686-9889
Practice Address - Street 1:837 58TH ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3662
Practice Address - Country:US
Practice Address - Phone:718-686-9888
Practice Address - Fax:718-686-9889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052424-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1487746475OtherNPI, INDIVIDUAL