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General NPI Number Information
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NPI Number | 1992918288
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Entity Type | Organization
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Legal Business Name | WOODBRIDGE CENTRE DENTAL
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 294 WOODBRIDGE CENTER DRIVE
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City | WOODBRIDGE
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State | NJ
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Zip | 07095
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Country | US
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Telephone | 732-750-3080
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Fax | 732-750-3098
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Provider Business Mailing Address
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Address Line | 294 WOODBRIDGE CENTER DRIVE
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City | WOODBRIDGE
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State | NJ
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Zip | 07095
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Country | US
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Telephone | 732-750-3080
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Fax | 732-750-3098
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHREYAS SHAH
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Credential |
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Telephone | 732-750-3089
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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 | 22DI02287503
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License Number State | NJ
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