MEDICARE: DR. ROBERT BRILLMAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS-018003-L	PA

General Provider Information

NPI Number	:	1366445264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT BRILLMAN D.D.S.

Provider Business Mailing Address
First Line	:	4 RIDINGS WAY
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19382-7488
Country	:	US
Telephone Number	:	610-506-1895
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 RIDINGS WAY
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19382-7488
Country	:	US
Telephone Number	:	610-506-1895
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	10/16/2019

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