NPIMap

Organization Active NPI

Braden Dental of South Jersey PC

Doing business as Dentistry of South Jersey - West Deptford

  • General Practice Dentistry
  • West Deptford, NJ
National Provider Identifier
1700046216
Registry record updated May 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
22DI02152700 Issued in NJ
Legal business name
BRADEN DENTAL OF SOUTH JERSEY PC
Doing business as
Dentistry of South Jersey - West Deptford
Practice address
640 Kings Hwy
West Deptford, NJ 08096-3145
Phone
(856) 845-4225
Fax
(856) 845-4221
NPI assigned
Jun 10, 2008
Last updated
May 21, 2024By the provider in NPPES
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
Dr. Douglas Sherly, D.M.D,
Title
President
Phone
(609) 560-5902

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 22DI02152700 NJ Primary

Addresses

Primary practice location

640 Kings Hwy
West Deptford, NJ 08096-3145

Mailing address

640 Kings Hwy
West Deptford, NJ 08096-3145
Phone (856) 845-4225

Other names 1

  • Dentistry of South Jersey - West Deptford 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

530 Crown Point Rd
Ste 5
West Deptford, NJ 08086

NPI Registry JSON

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

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716249600000",
    "number": "1700046216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 KINGS HWY",
            "city": "WEST DEPTFORD",
            "state": "NJ",
            "postal_code": "080963145",
            "telephone_number": "856-845-4225",
            "fax_number": "856-845-4221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 KINGS HWY",
            "city": "WEST DEPTFORD",
            "state": "NJ",
            "postal_code": "080963145",
            "telephone_number": "856-845-4225",
            "fax_number": "856-845-4221"
        }
    ],
    "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": "2008-06-10",
        "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",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D,"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02152700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dentistry of South Jersey - West Deptford",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Deptford, 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.