| Gary Brousell, D.d.s.pa | |
|
21 Gilbert St. Tinton Fall NJ 07724 | |
| (732) 747-0993 | |
| (732) 747-0961 |
| Full Name | Gary Brousell, D.d.s.pa |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 21 Gilbert St., Tinton Fall, New Jersey |
| Authorized Official Name and Position | Gary M Brousell (PRESIDENT) |
| Authorized Official Contact | 7327470993 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gary Brousell, D.d.s.pa 31 Wardell Cir Oceanport NJ 07757-1610 Ph: (732) 539-5600 | Gary Brousell, D.d.s.pa 21 Gilbert St. Tinton Fall NJ 07724 Ph: (732) 747-0993 |
| NPI Number | 1760520670 |
|---|---|
| Provider Enumeration Date | 02/02/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760520670 | NPI | - | NPPES |
| 1863401 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DI10690 (New Jersey) | Primary |