Provider Demographics
NPI:1295907913
Name:BRILLIANT DENTAL & ASSOCIATES, PC
Entity type:Organization
Organization Name:BRILLIANT DENTAL & ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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 AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226
Mailing Address - Country:US
Mailing Address - Phone:718-693-9811
Mailing Address - Fax:718-693-2577
Practice Address - Street 1:820 FLATBUSH AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226
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:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0496541223P0300X
NY0522851223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty