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SHORE ORAL MAXILLO SURGERY GROUP PA NPI 1619104015


NPI Information

NPI: 1619104015
Provider Name: SHORE ORAL MAXILLO SURGERY GROUP PA
Classification: Dentist - 1223S0112X
Entity Type: Organization

Specialization: Oral and Maxillofacial Surgery

Address:
301 MADISON AVE
LAKEWOOD, NJ
ZIP 08701
Phone: (732) 367-4042
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SHORE ORAL MAXILLO SURGERY GROUP PA is an oral and maxillofacial surgery dentist in Lakewood, NJ. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. SHORE ORAL MAXILLO SURGERY GROUP PA NPI is 1619104015. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

301 MADISON AVE
LAKEWOOD, NJ
ZIP 08701-266
Phone: (732) 367-4042
Fax: (732) 905-9210

The provider's authorized official is Richard L Gaines .
The authorized official title is Ower and has the following contact phone number (732) 367-4042.

The enumeration date for this NPI number is 6/12/2009 and was last updated on 6/12/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223S0112XDentistOral and Maxillofacial SurgeryDI09103NEW JERSEYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11642006MEDICAIDNEW JERSEY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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