Provider Demographics
NPI:1447702881
Name:MANVILLE FAMILY DENTAL PC
Entity type:Organization
Organization Name:MANVILLE FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER / VP
Authorized Official - Prefix:MR
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHPANER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-725-0900
Mailing Address - Street 1:35 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08835-1801
Mailing Address - Country:US
Mailing Address - Phone:908-725-0900
Mailing Address - Fax:908-725-0907
Practice Address - Street 1:35 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08835-1801
Practice Address - Country:US
Practice Address - Phone:908-725-0900
Practice Address - Fax:908-725-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020185001223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty