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General NPI Number Information
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NPI Number | 1871653113
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Entity Type | Individual
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Provider Name | THEODORE A. OSHETSKY D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 60 STATE ROUTE 36 STE B2
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764-1428
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Country | US
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Telephone | 732-229-5004
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Fax | 732-229-0599
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Provider Business Mailing Address
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Address Line | 6 MAPLE PL
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City | OCEANPORT
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State | NJ
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Zip | 07757-1625
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Country | US
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Telephone | 732-263-1282
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 22DI01409700
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License Number State | NJ
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