Provider Demographics
NPI:1184743908
Name:MARK D SHEKLIAN, DMD, PA
Entity type:Organization
Organization Name:MARK D SHEKLIAN, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:SHEKLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-449-8700
Mailing Address - Street 1:1330 LAUREL AVE
Mailing Address - Street 2:BLDG 3, STE 301
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-2300
Mailing Address - Country:US
Mailing Address - Phone:732-449-8700
Mailing Address - Fax:732-449-8177
Practice Address - Street 1:1330 LAUREL AVE
Practice Address - Street 2:BLDG 3, STE 301
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-2300
Practice Address - Country:US
Practice Address - Phone:732-449-8700
Practice Address - Fax:732-449-8177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ151401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty