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General NPI Number Information
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NPI Number | 1669892709
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Entity Type | Organization
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Legal Business Name | SHORE ENDODONTICS OF SEA GIRT PA
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Dates
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Enumeration Date | 04/16/2014
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Last Update Date | 04/16/2014
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Provider Practice Location Address
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Address Line | 2130 HIGHWAY 35
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City | SEA GIRT
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State | NJ
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Zip | 08750-1010
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Country | US
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Telephone | 732-893-8600
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Fax | 732-359-6165
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Provider Business Mailing Address
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Address Line | 2130 HIGHWAY 35
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City | SEA GIRT
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State | NJ
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Zip | 08750-1010
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Country | US
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Telephone | 732-893-8600
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Fax | 732-359-6165
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Authorized Official
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Title or Position | ENDODONTIST
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Name | DR. RAJEEV GUPTA
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Credential | D.D.S.
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Telephone | 732-349-9222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 22DI02077300
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License Number State | NJ
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