Healthcare Provider Details

I. General information

NPI: 1114215027
Provider Name (Legal Business Name): BRIAN JOSEPH ROONEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2291 ROUTE 33 STE 1002
HAMILTON NJ
08690
US

IV. Provider business mailing address

2291 ROUTE 33 STE 1002
HAMILTON NJ
08690-1717
US

V. Phone/Fax

Practice location:
  • Phone: 609-588-5601
  • Fax: 609-588-5602
Mailing address:
  • Phone: 609-588-5601
  • Fax: 609-588-5602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number60413
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS039849
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI02572500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: