Basic Information
| Provider Information | |||||||||
| NPI: | 1477888089 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRILLIANT | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | PHILIP | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9862 MISSION GORGE RD | ||||||||
| Address2: | SUITE E | ||||||||
| City: | SANTEE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920713873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195961600 | ||||||||
| FaxNumber: | 6195961680 | ||||||||
| Practice Location | |||||||||
| Address1: | 9862 MISSION GORGE RD | ||||||||
| Address2: | SUITE E | ||||||||
| City: | SANTEE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920713873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195961600 | ||||||||
| FaxNumber: | 6195961680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2009 | ||||||||
| LastUpdateDate: | 11/30/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 59733 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.