Provider Demographics
NPI:1962857573
Name:COMPASSIONATE CARE ORAL SURGERY LLC
Entity Type:Organization
Organization Name:COMPASSIONATE CARE ORAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BREVARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-385-7843
Mailing Address - Street 1:1035 N BLACK HORSE PIKE
Mailing Address - Street 2:SUITE #7
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-2840
Mailing Address - Country:US
Mailing Address - Phone:856-740-1300
Mailing Address - Fax:856-740-1302
Practice Address - Street 1:1035 N BLACK HORSE PIKE
Practice Address - Street 2:SUITE #7
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-2840
Practice Address - Country:US
Practice Address - Phone:856-740-1300
Practice Address - Fax:856-740-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO2212104261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center