MEDICARE: BRILLIANT SMILES OF BOCA RATON LLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1700661329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRILLIANT SMILES OF BOCA RATON LLC

Provider Business Mailing Address
First Line	:	315 SE MIZNER BLVD STE 216
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33432-6086
Country	:	US
Telephone Number	:	561-338-5005
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 SE MIZNER BLVD STE 216
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33432-6086
Country	:	US
Telephone Number	:	561-338-5005
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PATRICIA O BRANDAO
Credential	:	DMD
Telephone Number	:	561-338-5005

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	08/30/2023

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