Healthcare Provider Details

I. General information

NPI: 1134619398
Provider Name (Legal Business Name): THOMAS P MAHER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 E BAY AVE
MANAHAWKIN NJ
08050-3105
US

IV. Provider business mailing address

165 E BAY AVE
MANAHAWKIN NJ
08050-3105
US

V. Phone/Fax

Practice location:
  • Phone: 215-214-6401
  • Fax:
Mailing address:
  • Phone: 267-214-6401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number23DI03169800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: