Provider Demographics
NPI:1831277979
Name:PEDIATRIC DENTAL CARE
Entity type:Organization
Organization Name:PEDIATRIC DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-544-0050
Mailing Address - Street 1:167 AVENUE OF THE CMN STE 16
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4557
Mailing Address - Country:US
Mailing Address - Phone:732-544-0050
Mailing Address - Fax:732-544-0661
Practice Address - Street 1:167 AVENUE OF THE CMN STE 16
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4557
Practice Address - Country:US
Practice Address - Phone:732-544-0050
Practice Address - Fax:732-544-0661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ89181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6167OtherDELTA DENTAL PIN NUMBER