Provider Demographics
NPI:1629287297
Name:BRUNTON, ERICA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:
Last Name:BRUNTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 ROOME ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-1631
Mailing Address - Country:US
Mailing Address - Phone:973-706-8220
Mailing Address - Fax:
Practice Address - Street 1:111 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2701
Practice Address - Country:US
Practice Address - Phone:973-627-6053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023405001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice