MEDICARE: SARAH C. BREVET D.M.D.

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	22DI02152300	NJ

General Provider Information

NPI Number	:	1659493294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH C. BREVET D.M.D.

Provider Business Mailing 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	:	732-774-8708

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	:	732-774-8708

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	03/31/2015

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