Healthcare Provider Details

I. General information

NPI: 1851436919
Provider Name (Legal Business Name): DALE C WHILDEN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 MAIN AVE
OCEAN GROVE NJ
07756-1319
US

IV. Provider business mailing address

7 BROADWAY
OCEAN GROVE NJ
07756-1303
US

V. Phone/Fax

Practice location:
  • Phone: 732-774-8700
  • Fax:
Mailing address:
  • Phone: 732-774-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12295
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: