Provider Demographics
NPI:1225563877
Name:DIAMOND BEACH DENTAL
Entity Type:Organization
Organization Name:DIAMOND BEACH DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MASLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-522-3145
Mailing Address - Street 1:9850 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD CREST
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-3213
Mailing Address - Country:US
Mailing Address - Phone:609-522-3145
Mailing Address - Fax:609-522-9008
Practice Address - Street 1:9850 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:WILDWOOD CREST
Practice Address - State:NJ
Practice Address - Zip Code:08260-3213
Practice Address - Country:US
Practice Address - Phone:609-522-3145
Practice Address - Fax:609-522-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI12756122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty