Individual
DR. GARY M BROUSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
21 GILBERT STREET, TINTON FALLS, NJ 07724
(732) 747-0993
(732) 747-0961
Mailing address
31 WARDELL CIR, OCEANPORT, NJ 07757-1610
(732) 747-0993
(732) 747-0961
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
10690
NJ
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
22DI0106000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1863401
—
NJ
Enumeration date
01/24/2006
Last updated
06/28/2012
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