Provider Demographics
NPI:1518099472
Name:DIGITALLY ENHANCED DENTISTRY
Entity Type:Organization
Organization Name:DIGITALLY ENHANCED DENTISTRY
Other - Org Name:SHALOM DENTAL LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN S
Authorized Official - Middle Name:S
Authorized Official - Last Name:UNGAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-333-3383
Mailing Address - Street 1:110 HILLSIDE BLVD, SUITE 5
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701
Mailing Address - Country:US
Mailing Address - Phone:732-333-3383
Mailing Address - Fax:815-301-9612
Practice Address - Street 1:110 HILLSIDE BLVD, SUITE 5
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701
Practice Address - Country:US
Practice Address - Phone:732-333-3383
Practice Address - Fax:815-301-9612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ122300000X, 122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty