Provider Demographics
NPI:1306135074
Name:EASTERN DENTAL OF MANAHAWKIN, LLC
Entity type:Organization
Organization Name:EASTERN DENTAL OF MANAHAWKIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DENTAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:FEILER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-489-0030
Mailing Address - Street 1:733 ROUTE 72 EAST
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050
Mailing Address - Country:US
Mailing Address - Phone:609-489-0030
Mailing Address - Fax:609-489-0031
Practice Address - Street 1:733 ROUTE 72 EAST
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050
Practice Address - Country:US
Practice Address - Phone:609-489-0030
Practice Address - Fax:609-489-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ109671223S0112X
NJ205091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty