Provider Demographics
NPI:1821105792
Name:VSN DENTAL PC
Entity Type:Organization
Organization Name:VSN DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VLADISLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIKHMANTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-617-8411
Mailing Address - Street 1:184 US HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8454
Mailing Address - Country:US
Mailing Address - Phone:732-617-8411
Mailing Address - Fax:732-617-8412
Practice Address - Street 1:184 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:ENGLISHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8454
Practice Address - Country:US
Practice Address - Phone:732-617-8411
Practice Address - Fax:732-617-8412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI209871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8174105Medicaid