Provider Demographics
NPI:1992118087
Name:LANOKA SHORES LLC
Entity type:Organization
Organization Name:LANOKA SHORES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-488-2325
Mailing Address - Street 1:249 S MAIN ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-2301
Mailing Address - Country:US
Mailing Address - Phone:609-488-2325
Mailing Address - Fax:609-488-2342
Practice Address - Street 1:249 S MAIN ST UNIT 4
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-2301
Practice Address - Country:US
Practice Address - Phone:609-488-2325
Practice Address - Fax:609-488-2342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty