Brookside Family Dental Corp

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D1020914 Issued in NJ

Legal business name

BROOKSIDE FAMILY DENTAL CORP

Practice address

399 Hoover Ave
Suite 1
Bloomfield, NJ 07003

Phone

(973) 566-6161

Fax

(973) 566-0866

NPI assigned

Apr 15, 2008

Last updated

Apr 15, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kinda Hanna YacoubNPI 1972638070

Title

DDS

Phone

(973) 566-6161

Specialties & licenses 1

Addresses

Other names 1

• Brookside Family Dental Former legal business name

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kinda Hanna Yacoub, DDS

  • Dentist
  • Bloomfield, NJ
  • NPI 1972638070
  NPD (past) Authorized official
• Mounzer Yacoub, M.D.

  • Obstetrics & Gynecology Physician
  • Bloomfield, NJ
  • NPI 1992091573
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208217600000",
    "number": "1053585612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "399 HOOVER AVE",
            "address_2": "SUITE 1",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "07003",
            "telephone_number": "973-566-6161",
            "fax_number": "973-566-0866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "399 HOOVER AVE",
            "address_2": "SUITE 1",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "07003",
            "telephone_number": "973-566-6161",
            "fax_number": "973-566-0866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSIDE FAMILY DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-15",
        "last_updated": "2008-04-15",
        "status": "A",
        "authorized_official_last_name": "YACOUB",
        "authorized_official_first_name": "KINDA",
        "authorized_official_middle_name": "HANNA",
        "authorized_official_title_or_position": "DDS",
        "authorized_official_telephone_number": "973-566-6161"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "D1020914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookside Family Dental",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Melissa Brinton, M.S.W, LCSW
• Bianca Briscese, PHARMD
• Broad St Pharmacy LLC
• Davaughn Brockett, BCBA
• Daniel S. Bromberg, PHD, ABPP
• Denise Michelle Brown, MSW, LSW
• Alberto A Brunetti, RPH
• Caroline Marie Buczynski, PA-C
• Mariel Buque, PH.D.
• Walter Robert Burbella, P.T.

• General Practice Dentistry in Bloomfield, NJ
• Providers in Bloomfield, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.