Brad J Convissar, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI02233900 Issued in NJ

Practice address

2 Rancocas Blvd
Mount Laurel, NJ 08054-2057

Phone

(856) 778-8655

Fax

(856) 231-7480

NPI assigned

Dec 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bradley J Convissar DMD PA

  • Dental Clinic/Center
  • Mount Laurel, NJ
  • NPI 1316607757
  NPD
• Gerald S. Convissar DDS PA

  • General Practice Dentistry
  • Mount Laurel, NJ
  • NPI 1750443206
  NPD (past)

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640908800000",
    "number": "1316009871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 BIRCHWOOD PARK DR N",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080031026",
            "telephone_number": "856-751-1226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 RANCOCAS BLVD",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080542057",
            "telephone_number": "856-778-8655",
            "fax_number": "856-231-7480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONVISSAR",
        "first_name": "BRAD",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2021-12-31",
        "certification_date": "2021-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02233900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Community Options, Inc
• Community Treatment Solutions
• Concentra Health Services, Inc.
• Carol Ann Conrad, LCSW
• Samantha Conte, M.D.
• Gerald Steven Convissar, DDS
• Cooper Family Medicine, PC
• Cooper Institute for Reproductive & Hormonal Disorders, PC
• Cooper University Hospital
• Joelle E Cope, OTR/L

• General Practice Dentistry in Mount Laurel, NJ
• Providers in Mount Laurel, 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 Dec 31, 2021; 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.