Provider Demographics
NPI:1679044846
Name:DENTAL COSMETIC CENTER OF NORTH BRUNSWICK PC
Entity Type:Organization
Organization Name:DENTAL COSMETIC CENTER OF NORTH BRUNSWICK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAMTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:848-702-0872
Mailing Address - Street 1:1648 ROUTE 130 NORTH
Mailing Address - Street 2:SUITE #5
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902
Mailing Address - Country:US
Mailing Address - Phone:732-821-8183
Mailing Address - Fax:732-510-5235
Practice Address - Street 1:1648 ROUTE 130 NORTH
Practice Address - Street 2:SUITE #5
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902
Practice Address - Country:US
Practice Address - Phone:732-821-8183
Practice Address - Fax:732-510-5235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty