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General NPI Number Information
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NPI Number | 1124112958
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Entity Type | Organization
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Legal Business Name | ABC PEDIATRIC DENTAL CARE, P.C.
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 810 ABBOTT BLVD STE 303
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City | FORT LEE
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State | NJ
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Zip | 07024-4116
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Country | US
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Telephone | 201-224-9968
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Fax | 201-224-9969
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Provider Business Mailing Address
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Address Line | 810 ABBOTT BLVD STE 303
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City | FORT LEE
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State | NJ
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Zip | 07024-4116
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Country | US
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Telephone | 201-224-9968
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Fax | 201-224-9969
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Authorized Official
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Title or Position | PRESIDENT/PEDIATRIC DENTIST
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Name | DR. MARIA K SHIN
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Credential |
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Telephone | 201-224-9968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DI020279
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License Number State | NJ
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