Healthcare Provider Details

I. General information

NPI: 1023027943
Provider Name (Legal Business Name): JERSEY SHORE DENTAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 STATE ROUTE 33
NEPTUNE NJ
07753-4860
US

IV. Provider business mailing address

1820 STATE ROUTE 33
NEPTUNE NJ
07753-4860
US

V. Phone/Fax

Practice location:
  • Phone: 732-774-5772
  • Fax: 732-774-5537
Mailing address:
  • Phone: 732-774-5772
  • Fax: 732-774-5537

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: DR. NEAL A YOLIN
Title or Position: VICE PRESIDENT
Credential: DDS
Phone: 732-774-5772