Shore Oral Maxillo Surgery Group PA

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DI09103 Issued in NJ

Legal business name

SHORE ORAL MAXILLO SURGERY GROUP PA

Practice address

301 Madison Ave
Lakewood, NJ 08701-3266

Phone

(732) 367-4042

Fax

(732) 905-9210

NPI assigned

Jun 12, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Richard L Gaines, D.M.D.

Title

Ower

Phone

(732) 367-4042

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1244764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244764800000",
    "number": "1619104015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 MADISON AVE",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087013266",
            "telephone_number": "732-367-4042",
            "fax_number": "732-905-9210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 MADISON AVE",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087013266",
            "telephone_number": "732-367-4042",
            "fax_number": "732-905-9210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORE ORAL MAXILLO SURGERY GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-12",
        "last_updated": "2009-06-12",
        "status": "A",
        "authorized_official_last_name": "GAINES",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWER",
        "authorized_official_telephone_number": "732-367-4042",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NJ",
            "license": "DI09103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1642006",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shore Area Invitro Labs PC
• Shore Health Care Center, Inc.
• Shore Imaging, P.C.
• Shore Institute for Reproductive Medicine,PC
• Shore Medicine LLC
• Shore Orthopaedic Group
• Shore Orthopaedic Group
• Shore Outpatient Surgicenter LLC
• Shore Point Medical Associates LLC
• Shore Point OB & GYN, LLC

• Oral and Maxillofacial Surgery (Dentist) in Lakewood, NJ
• Providers in Lakewood, NJ by specialty
• Oral and Maxillofacial Surgery (Dentist) in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2009; 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.