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General NPI Number Information
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NPI Number | 1811075864
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Entity Type | Organization
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Legal Business Name | JEFFREY MARTIN SHUBACH D.M.D.; F.A.G.D.; P.A.
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 02/14/2013
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Provider Practice Location Address
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Address Line | 1307 WHITE HORSE RD STAFFORDSHIRE PROFESSIONAL CNTR. E 502
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City | VOORHEES
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State | NJ
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Zip | 08043-2176
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Country | US
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Telephone | 856-435-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 154 LUCERNE BLVD
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City | CHERRY HILL
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State | NJ
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Zip | 08003-5115
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Country | US
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Telephone | 856-424-4785
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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. JEFFREY MARTIN SHUBACH
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Credential | D.M.D. F.A.G.D.
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Telephone | 856-435-3333
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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 | NJ 11095
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License Number State | NJ
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