# SHORE ORAL MAXILLO SURGERY GROUP PA

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

## Provider details

- **NPI number:** 1619104015
- **Authorized official:** DR. RICHARD L GAINES D.M.D. (OWER)
- **Authorized official phone:** (732) 367-4042

## Contact information

- **Practice address:** 301 MADISON AVE, LAKEWOOD, NJ 08701-3266
- **Practice address phone:** (732) 367-4042
- **Practice address fax:** (732) 905-9210
- **Mailing address:** 301 MADISON AVE, LAKEWOOD, NJ 08701-3266
- **Mailing address phone:** (732) 367-4042
- **Mailing address fax:** (732) 905-9210

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DI09103 | NJ | Yes |

## Other

- **Enumeration date:** 06/12/2009
- **Last updated:** 06/12/2009