Healthcare Provider Details

I. General information

NPI: 1770777245
Provider Name (Legal Business Name): DRS. BRILLIANT, ROTHENBERG & MEISTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18851 NE 29TH AVE SUITE 300
AVENTURA FL
33180-2808
US

IV. Provider business mailing address

18851 NE 29TH AVE SUITE 300
AVENTURA FL
33180-2808
US

V. Phone/Fax

Practice location:
  • Phone: 305-933-1415
  • Fax: 305-933-1920
Mailing address:
  • Phone: 305-933-1415
  • Fax: 305-933-1920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9558
License Number StateFL

VIII. Authorized Official

Name: MRS. MARGO K BRILLIANT
Title or Position: PARTNER
Credential: DDS
Phone: 305-933-1415