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General NPI Number Information
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NPI Number | 1891251831
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Entity Type | Organization
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Legal Business Name | REVOLUTIONARY BRIER HILL LLC
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Dates
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Enumeration Date | 02/14/2019
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Last Update Date | 02/14/2019
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Provider Practice Location Address
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Address Line | E7 BRIER HILL CT
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3336
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Country | US
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Telephone | 732-239-0565
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Fax |
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Provider Business Mailing Address
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Address Line | 1151 BROAD ST STE 216
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4328
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Country | US
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Telephone | 732-239-0565
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. FRANK FORTE
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Credential |
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Telephone | 732-239-0565
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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 |
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License Number State |
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