Provider Demographics
NPI:1396800603
Name:BRILLIANT, ERWIN (DDS)
Entity type:Individual
Prefix:
First Name:ERWIN
Middle Name:
Last Name:BRILLIANT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 BEACON ST
Mailing Address - Street 2:#206
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1460
Mailing Address - Country:US
Mailing Address - Phone:617-823-8603
Mailing Address - Fax:617-969-7172
Practice Address - Street 1:232 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2001
Practice Address - Country:US
Practice Address - Phone:617-969-8558
Practice Address - Fax:617-969-7172
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA929301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice