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General NPI Number Information
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NPI Number | 1205074457
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Entity Type | Organization
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Legal Business Name | JERSEY SHORE DENTAL CENTER
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Dates
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Enumeration Date | 01/27/2009
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Last Update Date | 01/27/2009
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Provider Practice Location Address
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Address Line | 1820 CORLIES AVE SUITE 8
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City | NEPTUNE
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State | NJ
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Zip | 07755
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Country | US
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Telephone | 732-774-5772
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Fax |
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Provider Business Mailing Address
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Address Line | 1820 CORLIES AVE SUITE 8
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City | NEPTUNE
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State | NJ
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Zip | 07755
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Country | US
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Telephone | 732-774-5772
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Fax |
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Authorized Official
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Title or Position | PRISEDENT
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Name | DR. KHALED ELDIN
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Credential | DDS
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Telephone | 732-774-5772
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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 | DI 21284
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License Number State | NJ
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