MEDICARE: SHORE ORTHODONTICS, PA

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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7468440001	OTHER	NY	PTAN

General Provider Information

NPI Number	:	1801245865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHORE ORTHODONTICS, PA

Provider Business Mailing Address
First Line	:	1510 HOOPER AVE
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-2228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 HOOPER AVE
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-2228
Country	:	US
Telephone Number	:	732-255-1516
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MELVIN HENRY PEARSON
Credential	:	DDS
Telephone Number	:	732-255-1516

Provider Enumeration Date	:	06/09/2016
Last Update Date	:	06/09/2016

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Directions to “SHORE ORTHODONTICS, PA ” Practice Location

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