Provider Demographics
NPI:1457574469
Name:BARNEGAT DENTAL PC
Entity Type:Organization
Organization Name:BARNEGAT DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANGREE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-698-7770
Mailing Address - Street 1:498 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-2422
Mailing Address - Country:US
Mailing Address - Phone:609-698-7770
Mailing Address - Fax:609-660-0663
Practice Address - Street 1:498 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-2422
Practice Address - Country:US
Practice Address - Phone:609-698-7770
Practice Address - Fax:609-660-0663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ129761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty