Provider Demographics
NPI:1447674338
Name:SHORE DENTAL SLEEP CARE
Entity type:Organization
Organization Name:SHORE DENTAL SLEEP CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-761-8300
Mailing Address - Street 1:273 ROUTE 34
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2437
Mailing Address - Country:US
Mailing Address - Phone:732-761-8300
Mailing Address - Fax:732-761-9771
Practice Address - Street 1:273 ROUTE 34
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2437
Practice Address - Country:US
Practice Address - Phone:732-761-8300
Practice Address - Fax:732-761-9771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI018330261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental