Provider Demographics
NPI:1215122379
Name:YOUR FAMILY DENTAL GROUP PC
Entity type:Organization
Organization Name:YOUR FAMILY DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JYOTI
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-246-8181
Mailing Address - Street 1:1 HANCOCK DRIVE
Mailing Address - Street 2:
Mailing Address - City:KENDELL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824
Mailing Address - Country:US
Mailing Address - Phone:732-246-8181
Mailing Address - Fax:732-246-4244
Practice Address - Street 1:646 HERMANN RD
Practice Address - Street 2:
Practice Address - City:NO BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-2833
Practice Address - Country:US
Practice Address - Phone:732-246-8181
Practice Address - Fax:732-246-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty