Provider Demographics
NPI:1316366628
Name:BRIONES DENTAL OFFICE,LLC
Entity Type:Organization
Organization Name:BRIONES DENTAL OFFICE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-222-9285
Mailing Address - Street 1:3592 JOHN F KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-3333
Mailing Address - Country:US
Mailing Address - Phone:201-222-9285
Mailing Address - Fax:
Practice Address - Street 1:3592 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-3333
Practice Address - Country:US
Practice Address - Phone:201-222-9285
Practice Address - Fax:201-222-9286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental