MEDICARE: SGBR PARTNERS PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0450373807	OTHER	NJ	NJ ENTITY ID

General Provider Information

NPI Number	:	1538713318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SGBR PARTNERS PC

Provider Business Mailing Address
First Line	:	2119 BROWNING RD
Second Line	:
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08110-1910
Country	:	US
Telephone Number	:	856-663-5472
Fax Number	:	856-663-5391

Provider Business Practice Location Address
First Line	:	2119 BROWNING RD
Second Line	:
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08110-1910
Country	:	US
Telephone Number	:	856-663-5472
Fax Number	:	856-663-5391

Authorized Official
Title or Position	:	OWNER
Name	:	GREGORY STRAIT
Credential	:	DMD
Telephone Number	:	856-663-5391

Provider Enumeration Date	:	07/30/2019
Last Update Date	:	07/30/2019

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Directions to “SGBR PARTNERS PC ” Practice Location

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