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General NPI Number Information
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NPI Number | 1225509300
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Entity Type | Organization
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Legal Business Name | DESTINATION DENTAL CARE, LLC
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 12/16/2018
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Provider Practice Location Address
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Address Line | 7 CEDAR GROVE LN STE 33
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City | SOMERSET
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State | NJ
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Zip | 08873
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Country | US
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Telephone | 732-469-8083
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Fax |
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Provider Business Mailing Address
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Address Line | 3 ANGEL PL
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City | SOMERSET
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State | NJ
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Zip | 08873-4122
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Country | US
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Telephone | 732-642-7670
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DHARA K SHAH
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Credential | DMD
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Telephone | 732-642-7670
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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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