Provider Demographics
NPI:1790863652
Name:DR. WAYNE GRABER AND DR. BRIAN M. PETERS, PA
Entity Type:Organization
Organization Name:DR. WAYNE GRABER AND DR. BRIAN M. PETERS, PA
Other - Org Name:BEAR BROOK COMMONS DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-906-0077
Mailing Address - Street 1:1941 OAK TREE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2059
Mailing Address - Country:US
Mailing Address - Phone:732-906-0077
Mailing Address - Fax:732-906-8286
Practice Address - Street 1:1941 OAK TREE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2059
Practice Address - Country:US
Practice Address - Phone:732-906-0077
Practice Address - Fax:732-906-8286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0137191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty