Bradley J Convissar DMD PA

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

BRADLEY J CONVISSAR DMD PA

Practice address

2 Rancocas Blvd
Mount Laurel, NJ 08054-2057

Phone

(856) 778-8655

NPI assigned

Dec 27, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Bradley J Convissar, DMD

Title

President

Phone

(856) 778-8655

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brad J Convissar, DMD

  • General Practice Dentistry
  • Mount Laurel, NJ
  • NPI 1316009871
  NPD
• Gerald Steven Convissar, DDS

  • General Practice Dentistry
  • Mount Laurel, NJ
  • NPI 1336200518
  NPD (past)

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

{
    "created_epoch": "1640563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640563200000",
    "number": "1316607757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 RANCOCAS BLVD",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080542057",
            "telephone_number": "856-778-8655"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADLEY J CONVISSAR DMD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-27",
        "last_updated": "2021-12-27",
        "certification_date": "2021-12-27",
        "status": "A",
        "authorized_official_last_name": "CONVISSAR",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "856-778-8655",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annette Marie Boulden, RD,MA
• Andrea Legath Bowers, MD
• Lester Bowie, M.D.
• Debra Boyd, RN
• Braden Partners LP
• Branches of Hope
• Warren I Brandwine, D.O.
• Emily D Brassard, LCSW
• Joshua G Bravo
• Breg, Inc.

• Dental Clinic/Center in Mount Laurel, NJ
• Providers in Mount Laurel, NJ by specialty
• Dental Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 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.