# PREMIER FAMILY DENTAL PC

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

## Provider details

- **NPI number:** 1962847020
- **Authorized official:** MRS. GIRA RATHOD (OFFICE MANAGER)
- **Authorized official phone:** (973) 772-4222

## Contact information

- **Practice address:** 520 CLIFTON AVE STE 4, 4, CLIFTON, NJ 07011-3247
- **Practice address phone:** (973) 772-4222
- **Practice address fax:** (973) 772-7652
- **Mailing address:** 520 CLIFTON AVE STE 4, 4, CLIFTON, NJ 07011-3247
- **Mailing address phone:** (973) 772-4222
- **Mailing address fax:** (973) 772-7652

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DI0227391 | NJ | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DI2443200 | NJ | — |

## Other

- **Enumeration date:** 05/02/2013
- **Last updated:** 05/02/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0227391 | — | NJ |
| 05 | — | 0255891 | — | NJ |