Provider Demographics
NPI:1457307332
Name:LAVERY, BRIAN EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:EDWARD
Last Name:LAVERY
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 1:2312 WHITEHORSE-MERCERVILLE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1953
Mailing Address - Country:US
Mailing Address - Phone:609-588-5600
Mailing Address - Fax:609-588-5610
Practice Address - Street 1:2312 WHITEHORSE-MERCERVILLE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-1953
Practice Address - Country:US
Practice Address - Phone:609-588-5600
Practice Address - Fax:609-588-5610
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ130481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice