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General NPI Number Information
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NPI Number | 1720696420
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Entity Type | Organization
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Legal Business Name | COASTAL MONMOUTH DENTAL SPECIALISTS, LLC
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Dates
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Enumeration Date | 07/19/2020
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Last Update Date | 07/19/2020
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Provider Practice Location Address
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Address Line | 1300 STATE ROUTE 35 PLAZA 1 SUITE 202
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City | OCEAN
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State | NJ
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Zip | 07712
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Country | US
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Telephone | 732-531-4411
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Fax | 732-531-3350
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Provider Business Mailing Address
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Address Line | 1300 STATE ROUTE 35 PLAZA 1 SUITE 202
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City | OCEAN
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State | NJ
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Zip | 07712
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Country | US
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Telephone | 732-531-4411
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Fax | 732-531-3350
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. ANDREW RICHARD SAMUEL
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Credential | DMD
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Telephone | 732-531-4411
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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 |
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License Number State |
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