Provider Demographics
NPI:1992273155
Name:BRICK DENTAL CARE
Entity type:Organization
Organization Name:BRICK DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADMASU
Authorized Official - Middle Name:NERRI
Authorized Official - Last Name:GIZACHEW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-580-9205
Mailing Address - Street 1:1683 ROUTE 88 STE C
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:
Mailing Address - Fax:
Practice Address - Street 1:1683 ROUTE 88 STE C
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:347-455-1108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AGN DENTAL PRACTICES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental