Provider Demographics
NPI:1952723264
Name:ENCORE DENTAL OF SHREWSBURY
Entity Type:Organization
Organization Name:ENCORE DENTAL OF SHREWSBURY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.M.D/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:EMMA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-268-8137
Mailing Address - Street 1:40 SHREWSBURY PLAZA
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702
Mailing Address - Country:US
Mailing Address - Phone:732-268-8137
Mailing Address - Fax:732-268-8149
Practice Address - Street 1:40 SHREWSBURY PLAZA
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702
Practice Address - Country:US
Practice Address - Phone:732-268-8137
Practice Address - Fax:732-268-8149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2201021524001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty