Provider Demographics
NPI:1699885707
Name:SHREWSBURY ORTHODONTICS PA
Entity type:Organization
Organization Name:SHREWSBURY ORTHODONTICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAGOULAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-544-0579
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746
Mailing Address - Country:US
Mailing Address - Phone:732-544-0579
Mailing Address - Fax:732-544-9022
Practice Address - Street 1:167 AVENUE AT THE COMMONS
Practice Address - Street 2:STE 16
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702
Practice Address - Country:US
Practice Address - Phone:732-544-0579
Practice Address - Fax:732-544-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI018590001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty