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General NPI Number Information
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NPI Number | 1376929497
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Entity Type | Organization
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Legal Business Name | BRILLIANT DENTAL CARE
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Dates
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Enumeration Date | 07/31/2015
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Last Update Date | 07/31/2015
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Provider Practice Location Address
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Address Line | 2701 MING AVE SPC 221
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City | BAKERSFIELD
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State | CA
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Zip | 93304-4441
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Country | US
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Telephone | 661-369-8910
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Fax | 661-369-8914
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Provider Business Mailing Address
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Address Line | 2701 MING AVE SPC 221
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City | BAKERSFIELD
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State | CA
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Zip | 93304-4441
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Country | US
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Telephone | 661-369-8910
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Fax | 661-369-8914
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALLEN MOSSAEI
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Credential |
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Telephone | 661-369-8910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 59083
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License Number State | CA
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