Healthcare Provider Details

I. General information

NPI: 1174443584
Provider Name (Legal Business Name): HOLISTIC DENTAL CENTER OF BRICK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 HIGHWAY 88
BRICK NJ
08724-3265
US

IV. Provider business mailing address

2095 HIGHWAY 88
BRICK NJ
08724-3265
US

V. Phone/Fax

Practice location:
  • Phone: 732-295-1616
  • Fax:
Mailing address:
  • Phone: 732-295-1616
  • Fax: 732-892-3570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SACHI SHAH
Title or Position: OWNER
Credential: DMD
Phone: 732-295-1616