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General NPI Number Information
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NPI Number | 1063284321
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Entity Type | Organization
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Legal Business Name | GPSDMD LLC
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Dates
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Enumeration Date | 10/30/2023
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 266 KING GEORGE RD STE A
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City | WARREN
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State | NJ
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Zip | 07059-5187
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Country | US
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Telephone | 732-763-6010
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Fax |
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Provider Business Mailing Address
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Address Line | 50 LIBERTY DR
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City | DAYTON
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State | NJ
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Zip | 08810-1614
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Country | US
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Telephone | 732-763-6010
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | GAURAV SHAH
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Credential | DMD
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Telephone | 732-763-6010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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