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General NPI Number Information
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NPI Number | 1386152874
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Entity Type | Organization
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Legal Business Name | BRAM DENTAL GROUP
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 12/04/2020
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Provider Practice Location Address
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Address Line | 607 STATION AVE
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City | HADDON HEIGHTS
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State | NJ
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Zip | 08035-1906
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Country | US
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Telephone | 856-547-0520
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Fax | 856-547-8685
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Provider Business Mailing Address
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Address Line | 13 ELDERBERRY DR
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City | MEDFORD
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State | NJ
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Zip | 08055-3802
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Country | US
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Telephone | 201-403-7615
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Fax |
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Authorized Official
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Title or Position | CFO BUSINESS ADMINISTRATOR
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Name | MR. ANIL DHULIPALLA
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Credential |
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Telephone | 201-463-6281
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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 | 22DI02448500
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License Number State | NJ
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