Healthcare Provider Details

I. General information

NPI: 1053857680
Provider Name (Legal Business Name): DR. SARAH C. BREVET, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2017
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 MAIN AVE
OCEAN GROVE NJ
07756-1319
US

IV. Provider business mailing address

18 WEBB AVE
OCEAN GROVE NJ
07756-1334
US

V. Phone/Fax

Practice location:
  • Phone: 732-774-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22D102152300
License Number StateNJ

VIII. Authorized Official

Name: SARAH BREVET
Title or Position: DENTIST
Credential:
Phone: 732-233-5079