| Shore Oral Maxillo Surgery Group Pa | |
|
301 Madison Ave Lakewood NJ 08701-3266 | |
| (732) 367-4042 | |
| (732) 905-9210 |
| Full Name | Shore Oral Maxillo Surgery Group Pa |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 301 Madison Ave, Lakewood, New Jersey |
| Authorized Official Name and Position | Richard L Gaines (OWER) |
| Authorized Official Contact | 7323674042 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shore Oral Maxillo Surgery Group Pa 301 Madison Ave Lakewood NJ 08701-3266 Ph: (732) 367-4042 | Shore Oral Maxillo Surgery Group Pa 301 Madison Ave Lakewood NJ 08701-3266 Ph: (732) 367-4042 |
| NPI Number | 1619104015 |
|---|---|
| Provider Enumeration Date | 06/12/2009 |
| Last Update Date | 06/12/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619104015 | NPI | - | NPPES |
| 1642006 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DI09103 (New Jersey) | Primary |
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