Provider Demographics
NPI:1942325386
Name:SHEKLIAN, MARK DENNIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DENNIS
Last Name:SHEKLIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-2907
Mailing Address - Country:US
Mailing Address - Phone:732-223-8833
Mailing Address - Fax:732-223-2542
Practice Address - Street 1:54 BROAD ST
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-2907
Practice Address - Country:US
Practice Address - Phone:732-223-8833
Practice Address - Fax:732-223-2542
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ151401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice