Healthcare Provider Details

I. General information

NPI: 1366445264
Provider Name (Legal Business Name): ROBERT BRILLMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 RIDINGS WAY
WEST CHESTER PA
19382-7488
US

IV. Provider business mailing address

4 RIDINGS WAY
WEST CHESTER PA
19382-7488
US

V. Phone/Fax

Practice location:
  • Phone: 610-506-1895
  • Fax:
Mailing address:
  • Phone: 610-506-1895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS-018003-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: