Provider Demographics
NPI:1992724074
Name:EDWARD V. SHAGAM, .D.D.S., P.A.
Entity type:Organization
Organization Name:EDWARD V. SHAGAM, .D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:V
Authorized Official - Last Name:SHAGAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-267-2266
Mailing Address - Street 1:9 GARDEN ST # 11
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-1839
Mailing Address - Country:US
Mailing Address - Phone:609-267-2266
Mailing Address - Fax:856-983-1334
Practice Address - Street 1:9 GARDEN ST # 11
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-1839
Practice Address - Country:US
Practice Address - Phone:609-267-2266
Practice Address - Fax:856-983-1334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDS 118331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty