Shore Oral and Maxillofacial Surgery, LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

22DI02243200 Issued in NJ

Legal business name

SHORE ORAL AND MAXILLOFACIAL SURGERY, LLC

Practice address

54 W Jimmie Leeds Rd
Suite 6
Galloway, NJ 08205-9438

Phone

(609) 748-9600

Fax

(609) 748-9611

NPI assigned

Aug 5, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Boris Kalika, DMD

Title

Owner

Phone

(609) 748-9600

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1312502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318896000000",
    "number": "1952680100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 W JIMMIE LEEDS RD",
            "address_2": "SUITE 6",
            "city": "GALLOWAY",
            "state": "NJ",
            "postal_code": "082059438",
            "telephone_number": "609-748-9600",
            "fax_number": "609-748-9611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 W JIMMIE LEEDS RD",
            "address_2": "SUITE 6",
            "city": "GALLOWAY",
            "state": "NJ",
            "postal_code": "082059438",
            "telephone_number": "609-748-9600",
            "fax_number": "609-748-9611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORE ORAL AND MAXILLOFACIAL SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-05",
        "last_updated": "2011-10-18",
        "status": "A",
        "authorized_official_last_name": "KALIKA",
        "authorized_official_first_name": "BORIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "609-748-9600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NJ",
            "license": "22DI02243200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharon Carroccia LCSW, LLC
• Victoria Sheeran
• Brandi Lynn Sheridan, MSW, LCSW
• Michael Edward Sheridan, MS,RD
• Shore Direct Care, LLC.
• Shore Orthopedic University Associates PA
• Shore Therapy
• Mary C Sibson, LCSW
• Joseph Louis Simmons, OTR
• Purna Singh

• Oral and Maxillofacial Surgery (Dentist) in Galloway, NJ
• Providers in Galloway, 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 Oct 18, 2011; 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.