Provider Demographics
NPI:1386152874
Name:BRAM DENTAL GROUP
Entity type:Organization
Organization Name:BRAM DENTAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DHULIPALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-463-6281
Mailing Address - Street 1:13 ELDERBERRY DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-3802
Mailing Address - Country:US
Mailing Address - Phone:201-403-7615
Mailing Address - Fax:
Practice Address - Street 1:607 STATION AVE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1906
Practice Address - Country:US
Practice Address - Phone:856-547-0520
Practice Address - Fax:856-547-8685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02448500261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental