Provider Demographics
NPI:1912123290
Name:SOMERSET DENTAL PC
Entity Type:Organization
Organization Name:SOMERSET DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-745-9898
Mailing Address - Street 1:1707 RT 27 SOUTH
Mailing Address - Street 2:HEMPSTEAD PLAZA
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3908
Mailing Address - Country:US
Mailing Address - Phone:732-745-9898
Mailing Address - Fax:732-745-9818
Practice Address - Street 1:1707 RT 27 SOUTH
Practice Address - Street 2:HEMPSTEAD PLAZA
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3908
Practice Address - Country:US
Practice Address - Phone:732-745-9898
Practice Address - Fax:732-745-9818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
807614OtherUNITED CONCORDIA
NJ9179730Medicaid