Healthcare Provider Details

I. General information

NPI: 1598610875
Provider Name (Legal Business Name): SHUPE DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 MAPLE AVE
RED BANK NJ
07701-1733
US

IV. Provider business mailing address

208 MAPLE AVE
RED BANK NJ
07701-1733
US

V. Phone/Fax

Practice location:
  • Phone: 732-747-1122
  • Fax:
Mailing address:
  • Phone: 732-747-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADAM SHUPE
Title or Position: OWNER
Credential: DDS
Phone: 732-850-5354