Healthcare Provider Details

I. General information

NPI: 1376204537
Provider Name (Legal Business Name): MONMOUTH DENTAL ARTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2022
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 MONMOUTH ROAD SUITE 6
OAKHURST NJ
07755
US

IV. Provider business mailing address

257 MONMOUTH ROAD SUITE 6
OAKHURST NJ
07755
US

V. Phone/Fax

Practice location:
  • Phone: 732-531-4165
  • Fax: 732-531-2610
Mailing address:
  • Phone: 732-531-4165
  • Fax: 732-531-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW ADLY
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 732-531-4165