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General NPI Number Information
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NPI Number | 1306135074
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Entity Type | Organization
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Legal Business Name | EASTERN DENTAL OF MANAHAWKIN, LLC
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Dates
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Enumeration Date | 04/04/2011
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Last Update Date | 04/04/2011
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Provider Practice Location Address
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Address Line | 733 ROUTE 72 EAST
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City | MANAHAWKIN
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State | NJ
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Zip | 08050
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Country | US
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Telephone | 609-489-0030
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Fax | 609-489-0030
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Provider Business Mailing Address
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Address Line | 733 ROUTE 72 EAST
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City | MANAHAWKIN
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State | NJ
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Zip | 08050
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Country | US
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Telephone | 609-489-0030
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Fax | 609-489-0031
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Authorized Official
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Title or Position | EXECUTIVE DENTAL DIRECTOR
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Name | DR. AARON FEILER
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Credential | D.D.S
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Telephone | 609-489-0030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 20509
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 10967
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License Number State | NJ
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