Provider Demographics
NPI:1124289947
Name:SHORE FAMILY DENTAL, P.C.
Entity type:Organization
Organization Name:SHORE FAMILY DENTAL, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:ANITA
Authorized Official - Last Name:SPARAGNA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-926-3222
Mailing Address - Street 1:222 NEW RD
Mailing Address - Street 2:CENTRAL PARK EAST, SUITE #803
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1299
Mailing Address - Country:US
Mailing Address - Phone:609-926-3222
Mailing Address - Fax:
Practice Address - Street 1:222 NEW RD
Practice Address - Street 2:CENTRAL PARK EAST, SUITE #803
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1299
Practice Address - Country:US
Practice Address - Phone:609-926-3222
Practice Address - Fax:609-601-6334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2013-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI015590001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty