MEDICARE: SHORE FAMILY DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1003892795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHORE FAMILY DENTAL

Provider Business Mailing Address
First Line	:	16 WASHINGTON ST
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-7643
Country	:	US
Telephone Number	:	732-914-1039
Fax Number	:	732-914-8472

Provider Business Practice Location Address
First Line	:	1358 HOOPER AVE
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-2882
Country	:	US
Telephone Number	:	732-914-1039
Fax Number	:	732-914-8472

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHEN ABBATICCHIO
Credential	:	DDS
Telephone Number	:	856-740-5009

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	02/20/2019

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Directions to “SHORE FAMILY DENTAL ” Practice Location

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