Provider Demographics
NPI:1497805139
Name:MICHAEL BRONSTEIN, D.M.D., P.A.
Entity Type:Organization
Organization Name:MICHAEL BRONSTEIN, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRONSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-848-6239
Mailing Address - Street 1:1040 COOPER ST
Mailing Address - Street 2:AT GRANT AVENUE
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3015
Mailing Address - Country:US
Mailing Address - Phone:856-848-6239
Mailing Address - Fax:856-848-3000
Practice Address - Street 1:1040 COOPER ST
Practice Address - Street 2:AT GRANT AVENUE
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-3015
Practice Address - Country:US
Practice Address - Phone:856-848-6239
Practice Address - Fax:856-848-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ 173781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty