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General NPI Number Information
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NPI Number | 1962857573
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Entity Type | Organization
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Legal Business Name | COMPASSIONATE CARE ORAL SURGERY LLC
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Dates
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Enumeration Date | 05/02/2016
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Last Update Date | 05/02/2016
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Provider Practice Location Address
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Address Line | 1035 N BLACK HORSE PIKE SUITE #7
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City | WILLIAMSTOWN
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State | NJ
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Zip | 08094-2840
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Country | US
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Telephone | 856-740-1300
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Fax | 856-740-1302
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Provider Business Mailing Address
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Address Line | 1035 N BLACK HORSE PIKE SUITE #7
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City | WILLIAMSTOWN
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State | NJ
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Zip | 08094-2840
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Country | US
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Telephone | 856-740-1300
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Fax | 856-740-1302
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Authorized Official
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Title or Position | ORAL SURGEON
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Name | DR. REBEKAH BREVARD
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Credential | DMD
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Telephone | 609-385-7843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 22DIO2212104
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License Number State | NJ
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