Individual
IRA S PORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2341 HIGHWAY 66, OCEAN, NJ 07712-3961
(732) 922-2255
(732) 922-2969
Mailing address
2341 HIGHWAY 66, OCEAN, NJ 07712-3961
(732) 922-2222
(732) 922-2969
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
11460
NJ
1223P0300X
Periodontics
Primary
11460
NJ
Other
Enumeration date
06/29/2009
Last updated
06/29/2009
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