Provider Demographics
NPI:1740322296
Name:SHUPIK, GREGORY M (DMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:M
Last Name:SHUPIK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1910 MARLTON PIKE E
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2123
Mailing Address - Country:US
Mailing Address - Phone:856-428-4746
Mailing Address - Fax:856-751-3975
Practice Address - Street 1:1910 MARLTON PIKE E
Practice Address - Street 2:SUITE 2
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2123
Practice Address - Country:US
Practice Address - Phone:856-428-4746
Practice Address - Fax:856-751-3975
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ22DI009718001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics