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General NPI Number Information
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NPI Number | 1275542128
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Entity Type | Organization
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Legal Business Name | DR. LAURENCE BREMMER, DMD, PA
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1162 SPRINGFIELD AVE
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City | MOUNTAINSIDE
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State | NJ
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Zip | 07092-2906
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Country | US
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Telephone | 908-789-2777
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Fax |
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Provider Business Mailing Address
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Address Line | 1162 SPRINGFIELD AVE
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City | MOUNTAINSIDE
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State | NJ
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Zip | 07092-2906
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Country | US
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Telephone | 908-789-2777
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAURENCE BREMMER
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Credential | DMD
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Telephone | 908-789-2777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DI11517
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License Number State | NJ
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