Healthcare Provider Details

I. General information

NPI: 1053608521
Provider Name (Legal Business Name): JOSHUA BRATT DMD PC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSHUA BRATT DMD PC

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 N LONG BEACH RD STE 3
ROCKVILLE CTR NY
11570-4438
US

IV. Provider business mailing address

PO BOX 749
MORRISVILLE VT
05661-0749
US

V. Phone/Fax

Practice location:
  • Phone: 516-764-7333
  • Fax: 516-764-2545
Mailing address:
  • Phone: 802-888-7585
  • Fax: 802-851-8313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN4224
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number016-0087001
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number016-0087001
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number16-0087001
License Number StateVT
# 5
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number057154
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: