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General NPI Number Information
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NPI Number | 1497805139
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Entity Type | Organization
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Legal Business Name | MICHAEL BRONSTEIN, D.M.D., P.A.
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1040 COOPER ST AT GRANT AVENUE
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City | WOODBURY
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State | NJ
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Zip | 08096-3015
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Country | US
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Telephone | 856-848-6239
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Fax | 856-848-3000
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Provider Business Mailing Address
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Address Line | 1040 COOPER ST AT GRANT AVENUE
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City | WOODBURY
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State | NJ
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Zip | 08096-3015
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Country | US
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Telephone | 856-848-6239
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Fax | 856-848-3000
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL BRONSTEIN
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Credential | D.M.D.
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Telephone | 856-848-6239
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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 | NJ 17378
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License Number State | NJ
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