| New Jersey Mobile Dental Practice, P.a. | |
|
24 Merchants Way Colts Neck NJ 07722-1570 | |
| (732) 431-7577 | |
| (732) 431-8070 |
| Full Name | New Jersey Mobile Dental Practice, P.a. |
|---|---|
| Speciality | Dentist |
| Location | 24 Merchants Way, Colts Neck, New Jersey |
| Authorized Official Name and Position | Stephen A Beukas (PRESIDENT) |
| Authorized Official Contact | 7324317577 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| New Jersey Mobile Dental Practice, P.a. 637 Wyckoff Ave Suite 236 Wyckoff NJ 07481-1438 Ph: (732) 431-7577 | New Jersey Mobile Dental Practice, P.a. 24 Merchants Way Colts Neck NJ 07722-1570 Ph: (732) 431-7577 |
| NPI Number | 1447379102 |
|---|---|
| Provider Enumeration Date | 03/27/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447379102 | NPI | - | NPPES |
| 6516301 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DI018346 (New Jersey) | Primary |
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