Provider Demographics
NPI:1437305463
Name:SHELDON WALTUCH DMD, MS
Entity Type:Organization
Organization Name:SHELDON WALTUCH DMD, MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTUCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:732-549-6286
Mailing Address - Street 1:3 HWY 27
Mailing Address - Street 2:COLONIAL VILLAGE PROF. BLDG SUITE 204
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3963
Mailing Address - Country:US
Mailing Address - Phone:732-549-6286
Mailing Address - Fax:732-549-5282
Practice Address - Street 1:3 HWY 27
Practice Address - Street 2:COLONIAL VILLAGE PROF. BLDG SUITE 204
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3963
Practice Address - Country:US
Practice Address - Phone:732-549-6286
Practice Address - Fax:732-549-5282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty