Provider Demographics
NPI:1316093495
Name:OCEAN PEDIATRIC DENTAL
Entity type:Organization
Organization Name:OCEAN PEDIATRIC DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-473-1123
Mailing Address - Street 1:368 LAKEHURST RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-7339
Mailing Address - Country:US
Mailing Address - Phone:732-473-1123
Mailing Address - Fax:732-473-1133
Practice Address - Street 1:368 LAKEHURST RD
Practice Address - Street 2:SUITE 305
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-7339
Practice Address - Country:US
Practice Address - Phone:732-473-1123
Practice Address - Fax:732-473-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ21316001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty