# PRIME DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659414233
- **Authorized official:** DR. DARSHNA MODY D.D.S (PRESIDENT)
- **Authorized official phone:** (732) 225-2300

## Contact information

- **Practice address:** 1036 AMBOY AVE, EDISON, NJ 08837-2806
- **Practice address phone:** (732) 225-2300
- **Practice address fax:** (732) 225-6336
- **Mailing address:** 1036 AMBOY AVE, EDISON, NJ 08837-2806
- **Mailing address phone:** (732) 225-2300
- **Mailing address fax:** (732) 225-6336

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DI18045 | NJ | Yes |

## Other

- **Enumeration date:** 02/14/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5386608 | — | NJ |