Provider Demographics
NPI:1629192174
Name:BRUNSDEN, CAVAN MICHAEL (DMD)
Entity Type:Individual
Prefix:
First Name:CAVAN
Middle Name:MICHAEL
Last Name:BRUNSDEN
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 1:2455 COUNTY ROAD 516
Mailing Address - Street 2:KIDZDENT CHILDREN'S DENTAL CARE
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1892
Mailing Address - Country:US
Mailing Address - Phone:732-679-2323
Mailing Address - Fax:
Practice Address - Street 1:2455 COUNTY ROAD 516
Practice Address - Street 2:KIDZDENT CHILDREN'S DENTAL CARE
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-1892
Practice Address - Country:US
Practice Address - Phone:732-679-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ128321223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry