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General NPI Number Information
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NPI Number | 1649834243
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Entity Type | Organization
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Legal Business Name | SHELTON ORAL SURGERY & IMPLANT CENTER, PC
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Dates
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Enumeration Date | 04/29/2019
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Last Update Date | 04/29/2019
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Provider Practice Location Address
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Address Line | 1146 STUYVESANT AVE
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City | IRVINGTON
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State | NJ
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Zip | 07111-1059
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Country | US
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Telephone | 973-849-6587
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Fax |
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Provider Business Mailing Address
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Address Line | 1146 STUYVESANT AVE
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City | IRVINGTON
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State | NJ
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Zip | 07111-1059
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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 | PRESIDENT
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Name | DR. ANDREW D KIM
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Credential | DDS
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Telephone | 973-849-6587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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