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General NPI Number Information
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NPI Number | 1043447543
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Entity Type | Individual
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Provider Name | AYANNA CELESTE BRADSHAW-SYDNOR D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/11/2009
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 72 N MUNN AVE APARTMENT #1
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City | EAST ORANGE
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State | NJ
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Zip | 07017-4122
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Country | US
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Telephone | 404-323-1569
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Fax |
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Provider Business Mailing Address
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Address Line | 275 HOBART ST JEWISH RENAISSANCE MEDICAL CENTER-DENTAL DEPARTMENT
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City | PERTH AMBOY
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State | NJ
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Zip | 08861-3396
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Country | US
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Telephone | 973-376-9333
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Fax | 973-293-0139
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22010248900
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License Number State | NJ
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