Provider Demographics
NPI:1023012598
Name:ROSHONG, BRYON ERNEST (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRYON
Middle Name:ERNEST
Last Name:ROSHONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-2908
Mailing Address - Country:US
Mailing Address - Phone:201-387-1555
Mailing Address - Fax:201-385-1268
Practice Address - Street 1:111 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-2908
Practice Address - Country:US
Practice Address - Phone:201-387-1555
Practice Address - Fax:201-385-1268
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-11
Last Update Date:2012-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI00996200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist