Provider Demographics
NPI:1083950158
Name:ERICA BRUNTON DMD LLC
Entity Type:Organization
Organization Name:ERICA BRUNTON DMD LLC
Other - Org Name:JEFFERSON FAMILY SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-663-4444
Mailing Address - Street 1:231 ESPANONG RD
Mailing Address - Street 2:
Mailing Address - City:LAKE HOPATCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07849-1788
Mailing Address - Country:US
Mailing Address - Phone:973-663-4444
Mailing Address - Fax:973-663-2866
Practice Address - Street 1:231 ESPANONG RD
Practice Address - Street 2:
Practice Address - City:LAKE HOPATCONG
Practice Address - State:NJ
Practice Address - Zip Code:07849-1788
Practice Address - Country:US
Practice Address - Phone:973-663-4444
Practice Address - Fax:973-663-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ234051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty