New Jersey Mobile Dental Practice, P.a.

Primary specialty

DentistTaxonomy code 122300000X

License

DI018346 Issued in NJ

Legal business name

NEW JERSEY MOBILE DENTAL PRACTICE, P.A.

Practice address

24 Merchants Way
Colts Neck, NJ 07722-1570

Phone

(732) 431-7577

Fax

(732) 431-8070

NPI assigned

Mar 27, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Stephen A Beukas, D.M.D.

Title

President

Phone

(732) 431-7577

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christopher Thomas Lillo, D.M.D.

  • Dentist
  • Toms River, NJ
  • NPI 1720150675
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1447379102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "637 WYCKOFF AVE",
            "address_2": "SUITE 236",
            "city": "WYCKOFF",
            "state": "NJ",
            "postal_code": "074811438",
            "telephone_number": "732-431-7577",
            "fax_number": "732-431-8070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 MERCHANTS WAY",
            "city": "COLTS NECK",
            "state": "NJ",
            "postal_code": "077221570",
            "telephone_number": "732-431-7577",
            "fax_number": "732-431-8070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW JERSEY MOBILE DENTAL PRACTICE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BEUKAS",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-431-7577",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NJ",
            "license": "DI018346",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6516301",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Colts Neck, NJ
• Providers in Colts Neck, NJ by specialty
• Dentist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.