1124289947 NPI number — SHORE FAMILY DENTAL, P.C.

Table of content: (NPI 1124289947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124289947 NPI number — SHORE FAMILY DENTAL, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHORE FAMILY DENTAL, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CLAIRE A. SPARAGNA, D.M.D.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124289947
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 NEW RD
Provider Second Line Business Mailing Address:
CENTRAL PARK EAST, SUITE #803
Provider Business Mailing Address City Name:
LINWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08221-1299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-926-3222
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 NEW RD
Provider Second Line Business Practice Location Address:
CENTRAL PARK EAST, SUITE #803
Provider Business Practice Location Address City Name:
LINWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08221-1299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-926-3222
Provider Business Practice Location Address Fax Number:
609-601-6334
Provider Enumeration Date:
06/24/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SPARAGNA
Authorized Official First Name:
CLAIRE
Authorized Official Middle Name:
ANITA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
609-926-3222

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  22DI01559000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)