# NEW JERSEY MOBILE DENTAL PRACTICE, P.A.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447379102
- **Authorized official:** DR. STEPHEN A BEUKAS D.M.D. (PRESIDENT)
- **Authorized official phone:** (732) 431-7577

## Contact information

- **Practice address:** 24 MERCHANTS WAY, COLTS NECK, NJ 07722-1570
- **Practice address phone:** (732) 431-7577
- **Practice address fax:** (732) 431-8070
- **Mailing address:** 637 WYCKOFF AVE, SUITE 236, WYCKOFF, NJ 07481-1438
- **Mailing address phone:** (732) 431-7577
- **Mailing address fax:** (732) 431-8070

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DI018346 | NJ | Yes |

## Other

- **Enumeration date:** 03/27/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6516301 | — | NJ |