Healthcare Provider Details

I. General information

NPI: 1932380284
Provider Name (Legal Business Name): JEFFREY SHORE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 CHESTER PIKE
NORWOOD PA
19074-1416
US

IV. Provider business mailing address

519 CHESTER PIKE P.O. BOX 40
NORWOOD PA
19074-1416
US

V. Phone/Fax

Practice location:
  • Phone: 610-532-3700
  • Fax: 610-532-9842
Mailing address:
  • Phone: 610-532-3700
  • Fax: 610-532-9842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS021439L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: