Provider Demographics
NPI:1669474144
Name:BRATTER, PAUL BURT (DMD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:BURT
Last Name:BRATTER
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 1:6 FRANK E RODGERS BLVD N
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-1401
Mailing Address - Country:US
Mailing Address - Phone:973-484-3443
Mailing Address - Fax:973-484-3443
Practice Address - Street 1:6 FRANK E RODGERS BLVD N
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-1401
Practice Address - Country:US
Practice Address - Phone:973-484-3443
Practice Address - Fax:973-484-3443
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice