MEDICARE: DR. SARAH C. BREVET, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22D102152300	NJ

General Provider Information

NPI Number	:	1053857680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. SARAH C. BREVET, LLC

Provider Business Mailing Address
First Line	:	18 WEBB AVE
Second Line	:
City	:	OCEAN GROVE
State	:	NJ
Zip	:	07756-1334
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	64 MAIN AVE
Second Line	:
City	:	OCEAN GROVE
State	:	NJ
Zip	:	07756-1319
Country	:	US
Telephone Number	:	732-774-8700
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	SARAH BREVET
Credential	:
Telephone Number	:	732-233-5079

Provider Enumeration Date	:	01/06/2017
Last Update Date	:	01/06/2017

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