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General NPI Number Information
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NPI Number | 1376694844
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Entity Type | Individual
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Provider Name | STEPHEN DOMINICK BRATTELLI DMD
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Gender | Male
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Dates
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Enumeration Date | 01/13/2007
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Last Update Date | 01/16/2016
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Provider Practice Location Address
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Address Line | 15 COLBY AVE
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City | STRATFORD
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State | NJ
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Zip | 08084-1028
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Country | US
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Telephone | 856-782-0103
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Fax |
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Provider Business Mailing Address
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Address Line | 14 SHENANDOAH DR
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City | VOORHEES
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State | NJ
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Zip | 08043-3308
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Country | US
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Telephone | 856-534-6245
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI01515800
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License Number State | NJ
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