Provider Demographics
NPI:1538357991
Name:PDG OF SHREWSBURY PA
Entity type:Organization
Organization Name:PDG OF SHREWSBURY PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-741-8707
Mailing Address - Street 1:850 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4214
Mailing Address - Country:US
Mailing Address - Phone:732-741-8707
Mailing Address - Fax:732-741-3421
Practice Address - Street 1:850 BROAD ST
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4214
Practice Address - Country:US
Practice Address - Phone:732-741-8707
Practice Address - Fax:732-741-3421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ14324122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty