Provider Demographics
NPI:1659451821
Name:EARL B BROKER DDS LLC
Entity Type:Organization
Organization Name:EARL B BROKER DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:B
Authorized Official - Last Name:BROKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-770-9200
Mailing Address - Street 1:2301 EVESHAM RD
Mailing Address - Street 2:SUITE 301 PAVILIONS OF VOORHEES
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043
Mailing Address - Country:US
Mailing Address - Phone:856-770-9200
Mailing Address - Fax:856-770-1838
Practice Address - Street 1:2301 EVESHAM RD
Practice Address - Street 2:SUITE 301 PAVILIONS OF VOORHEES
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-770-9200
Practice Address - Fax:856-770-1838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ7972122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty