Provider Demographics
NPI:1831502350
Name:BRICK DENTAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:BRICK DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-836-3002
Mailing Address - Street 1:1683 ROUTE 88
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3072
Mailing Address - Country:US
Mailing Address - Phone:732-836-3002
Mailing Address - Fax:732-836-3004
Practice Address - Street 1:1683 ROUTE 88
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3072
Practice Address - Country:US
Practice Address - Phone:732-836-3002
Practice Address - Fax:732-836-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02074800261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental