Provider Demographics
NPI:1649529124
Name:BRICKWORKS DENTAL, LLC
Entity type:Organization
Organization Name:BRICKWORKS DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:MENSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-625-0505
Mailing Address - Street 1:5429 HARDING HWY.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MAYS LANDINBG
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-2263
Mailing Address - Country:US
Mailing Address - Phone:609-625-0505
Mailing Address - Fax:609-625-8002
Practice Address - Street 1:5429 HARDING HWY.
Practice Address - Street 2:SUITE 101
Practice Address - City:MAYS LANDINBG
Practice Address - State:NJ
Practice Address - Zip Code:08330-2263
Practice Address - Country:US
Practice Address - Phone:609-625-0505
Practice Address - Fax:609-625-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty