Provider Demographics
NPI:1063667400
Name:JERSEY SHORE ENDODONTICS
Entity Type:Organization
Organization Name:JERSEY SHORE ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:O
Authorized Official - Last Name:SHEERAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-531-4411
Mailing Address - Street 1:1300 HWY 35
Mailing Address - Street 2:PLAZA I
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3537
Mailing Address - Country:US
Mailing Address - Phone:732-531-4411
Mailing Address - Fax:
Practice Address - Street 1:1300 HWY 35
Practice Address - Street 2:PLAZA I
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-3537
Practice Address - Country:US
Practice Address - Phone:732-531-4411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI155031223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty