Organization
GARY BROUSELL, D.D.S.PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY M BROUSELL D.D.S. (PRESIDENT)
(732) 747-0993
Entity
Organization
Contact information
Practice address
21 GILBERT ST., TINTON FALL, NJ 07724
(732) 747-0993
(732) 747-0961
Mailing address
31 WARDELL CIR, OCEANPORT, NJ 07757-1610
(732) 539-5600
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DI10690
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1863401
—
NJ
Enumeration date
02/02/2007
Last updated
08/22/2020
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