MEDICARE: DR. DALE C. WHILDEN, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	22DI01229500	NJ

General Provider Information

NPI Number	:	1184898165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. DALE C. WHILDEN, LLC

Provider Business Mailing Address
First Line	:	64 MAIN AVE
Second Line	:
City	:	OCEAN GROVE
State	:	NJ
Zip	:	07756-1319
Country	:	US
Telephone Number	:	732-774-8700
Fax Number	:	732-774-8708

Provider Business Practice Location Address
First Line	:	64 MAIN AVE
Second Line	:
City	:	OCEAN GROVE
State	:	NJ
Zip	:	07756-1319
Country	:	US
Telephone Number	:	732-774-8700
Fax Number	:	732-774-8708

Authorized Official
Title or Position	:	SINGLE MEMBER/OWNER
Name	:	DR. DALE C WHILDEN
Credential	:	D.M.D.
Telephone Number	:	732-774-8700

Provider Enumeration Date	:	04/21/2008
Last Update Date	:	02/04/2014

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