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General NPI Number Information
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NPI Number | 1356895791
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Entity Type | Organization
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Legal Business Name | SHON DENTAL GROUP PC
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Dates
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Enumeration Date | 08/14/2016
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Last Update Date | 08/14/2016
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Provider Practice Location Address
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Address Line | 20 BROADWAY
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City | PASSAIC
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State | NJ
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Zip | 07055-5006
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Country | US
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Telephone | 917-951-8657
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Fax |
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Provider Business Mailing Address
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Address Line | 2448 3RD ST
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City | FORT LEE
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State | NJ
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Zip | 07024-4039
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. YOUNG SHON
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Credential | DDS
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Telephone | 917-951-8657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02423600
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License Number State | NJ
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