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General NPI Number Information
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NPI Number | 1700046216
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Entity Type | Organization
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Legal Business Name | BRADEN DENTAL OF SOUTH JERSEY PC
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 640 KINGS HWY
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City | WEST DEPTFORD
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State | NJ
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Zip | 08096-3145
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Country | US
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Telephone | 856-845-4225
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Fax | 856-845-4221
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Provider Business Mailing Address
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Address Line | 640 KINGS HWY
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City | WEST DEPTFORD
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State | NJ
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Zip | 08096-3145
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Country | US
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Telephone | 856-845-4225
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Fax | 856-845-4221
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOUGLAS SHERLY
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Credential | D.M.D,
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Telephone | 609-560-5902
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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 | 22DI02152700
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License Number State | NJ
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