NPIMap

Organization Active NPI

Braden Dental of South Jersey PC

  • General Practice Dentistry
  • Pennsville, NJ
National Provider Identifier
1619722469
Registry record updated May 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
BRADEN DENTAL OF SOUTH JERSEY PC
Practice address
160 S Broadway
Pennsville, NJ 08070-2220
Phone
(856) 678-5124
NPI assigned
Apr 23, 2024
Organization subpart
Yes
Parent organization
BRADEN DENTAL OF SOUTH JERSEY PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 21, 2024

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

Authorized official

Name
Douglas SherlyNPI 1811059033
Title
President
Phone
(609) 560-5902

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

160 S Broadway
Pennsville, NJ 08070-2220

Mailing address

160 S Broadway
Pennsville, NJ 08070-2220
Phone (856) 678-5124

Other names 1

  • Dentistry of South Jersey-Pennsville Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Braden Dental of South Jersey PC6 organizations share this tax ID, including this one
Part of
Braden Dental of South Jersey PC

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

160 S Broadway
Pennsville, NJ 08070
Phone (856) 678-5124

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1713830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716249600000",
    "number": "1619722469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 S BROADWAY",
            "city": "PENNSVILLE",
            "state": "NJ",
            "postal_code": "080702220",
            "telephone_number": "856-678-5124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 S BROADWAY",
            "city": "PENNSVILLE",
            "state": "NJ",
            "postal_code": "080702220",
            "telephone_number": "856-678-5124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADEN DENTAL OF SOUTH JERSEY PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRADEN DENTAL OF SOUTH JERSEY PC",
        "enumeration_date": "2024-04-23",
        "last_updated": "2024-05-21",
        "certification_date": "2024-05-21",
        "status": "A",
        "authorized_official_last_name": "SHERLY",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "609-560-5902"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dentistry of South Jersey-Pennsville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dentistry of South Jersey-Pennsville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pennsville, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2024; 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.