Provider Demographics
NPI:1912521865
Name:DINOWITZ, JUSTIN SHANE (DMD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:SHANE
Last Name:DINOWITZ
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 1:124 MICKI DR
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1659
Mailing Address - Country:US
Mailing Address - Phone:732-535-0538
Mailing Address - Fax:
Practice Address - Street 1:2455 ROUTE 516 FL 1
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-1892
Practice Address - Country:US
Practice Address - Phone:732-679-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ22DI028303001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program