MEDICARE: DENTAL CARE OF BRIGANTINE, 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	18248	NJ

General Provider Information

NPI Number	:	1538352620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL CARE OF BRIGANTINE, LLC

Provider Business Mailing Address
First Line	:	4276 HARBOR BEACH BLVD STE B
Second Line	:	BRIGANTINE TOWNE CENTER
City	:	BRIGANTINE
State	:	NJ
Zip	:	08203-1363
Country	:	US
Telephone Number	:	609-266-6658
Fax Number	:	609-266-5990

Provider Business Practice Location Address
First Line	:	1500 S LINCOLN AVE
Second Line	:
City	:	VINELAND
State	:	NJ
Zip	:	08361-6610
Country	:	US
Telephone Number	:	856-691-2553
Fax Number	:	856-691-3370

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. MICKEY PERRY
Credential	:
Telephone Number	:	609-266-6658

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	08/22/2007

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