Provider Demographics
NPI:1417106444
Name:BRUNSWICK VALLEY ORTHODONTICS, LLC
Entity Type:Organization
Organization Name:BRUNSWICK VALLEY ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:STERITT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-398-1900
Mailing Address - Street 1:3176 RT 27
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824
Mailing Address - Country:US
Mailing Address - Phone:732-396-1900
Mailing Address - Fax:732-398-9791
Practice Address - Street 1:3176 RT 27
Practice Address - Street 2:SUITE 1B
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824
Practice Address - Country:US
Practice Address - Phone:732-396-1900
Practice Address - Fax:732-398-9791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1010683001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty