Provider Demographics
NPI:1376823500
Name:SHREWSBURY FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:SHREWSBURY FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-747-9333
Mailing Address - Street 1:555 SHREWSBURY AVE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4178
Mailing Address - Country:US
Mailing Address - Phone:732-747-9333
Mailing Address - Fax:732-747-6365
Practice Address - Street 1:555 SHREWSBURY AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4178
Practice Address - Country:US
Practice Address - Phone:732-747-9333
Practice Address - Fax:732-747-6365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ231951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty