Provider Demographics
NPI:1245944552
Name:BRILOWSKI FAMILY DENTISTRY SC
Entity type:Organization
Organization Name:BRILOWSKI FAMILY DENTISTRY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BRILOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-364-7079
Mailing Address - Street 1:17000 W CAPITOL DR STE 12
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2158
Mailing Address - Country:US
Mailing Address - Phone:262-373-0775
Mailing Address - Fax:
Practice Address - Street 1:17000 W CAPITOL DR STE 12
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2158
Practice Address - Country:US
Practice Address - Phone:262-373-0775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty