Healthcare Provider Details

I. General information

NPI: 1932273711
Provider Name (Legal Business Name): BRUCE KERENSKY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E EVESHAM ROAD
GLENDORA NJ
08029
US

IV. Provider business mailing address

120 E EVESHAM ROAD
GLENDORA NJ
08029
US

V. Phone/Fax

Practice location:
  • Phone: 856-939-0771
  • Fax: 856-939-0774
Mailing address:
  • Phone: 856-939-0771
  • Fax: 856-939-0774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22D101343000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: