Provider Demographics
NPI:1376694844
Name:BRATTELLI, STEPHEN DOMINICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DOMINICK
Last Name:BRATTELLI
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 1:14 SHENANDOAH DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3308
Mailing Address - Country:US
Mailing Address - Phone:856-534-6245
Mailing Address - Fax:
Practice Address - Street 1:15 COLBY AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1028
Practice Address - Country:US
Practice Address - Phone:856-782-0103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01515800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist