MEDICARE: SHORE ORTHODONTICS PA

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry		NJ

General Provider Information

NPI Number	:	1255532644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHORE ORTHODONTICS PA

Provider Business Mailing Address
First Line	:	1510 HOOPER AVE
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-2228
Country	:	US
Telephone Number	:	732-255-1516
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 HOOPER AVE
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-2228
Country	:	US
Telephone Number	:	732-255-1516
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. EDWARD S BOIM
Credential	:	D.D.S.
Telephone Number	:	732-255-1516

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	08/22/2020

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Directions to “SHORE ORTHODONTICS PA ” Practice Location

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