Provider Demographics
NPI:1053608521
Name:BRATT, JOSHUA (DMD PC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:BRATT
Suffix:
Gender:M
Credentials:DMD PC
Other - Prefix:DR
Other - First Name:JOSHUA
Other - Middle Name:
Other - Last Name:BRATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD PC
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-0749
Mailing Address - Country:US
Mailing Address - Phone:802-888-7585
Mailing Address - Fax:802-851-8313
Practice Address - Street 1:143 N LONG BEACH RD STE 3
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CTR
Practice Address - State:NY
Practice Address - Zip Code:11570-4438
Practice Address - Country:US
Practice Address - Phone:516-764-7333
Practice Address - Fax:516-764-2545
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4224122300000X
VT016-0087001122300000X, 1223D0001X
VT16-00870011223D0001X
NY057154122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1021135Medicaid