Individual
DR. BRAD J CONVISSAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2 RANCOCAS BLVD, MOUNT LAUREL, NJ 08054-2057
(856) 778-8655
(856) 231-7480
Mailing address
1950 BIRCHWOOD PARK DR N, CHERRY HILL, NJ 08003-1026
(856) 751-1226
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI02233900
NJ
Other
Enumeration date
12/14/2006
Last updated
12/31/2021
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