MEDICARE: EUGENE BRADIN DDS

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	22DI00725800	NJ

General Provider Information

NPI Number	:	1235234261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE BRADIN DDS

Provider Business Mailing Address
First Line	:	466 S ARTHUR DR
Second Line	:
City	:	BEVERLY
State	:	NJ
Zip	:	08010-2154
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	466 S ARTHUR DR
Second Line	:
City	:	BEVERLY
State	:	NJ
Zip	:	08010-2154
Country	:	US
Telephone Number	:	609-387-4774
Fax Number	:

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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