Organization
PREMIUM DENTISTRY
Active
Parent organization
DENTAL ASSOCIATES OF LAKEWOOD
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL ASSOCIATES OF LAKEWOOD
Authorized official
ANDRE SHIVRATTAN (CREDENTIALING SPECIALIST)
(347) 579-5159
Entity
Organization
Contact information
Practice address
6 W SPRUCE ST, LAKEWOOD, NJ 08701-5007
(732) 364-5100
(201) 927-3474
Mailing address
6 W SPRUCE ST, LAKEWOOD, NJ 08701-5007
(732) 364-5100
(201) 927-3474
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22DI01842800
NJ
Other
Enumeration date
05/09/2018
Last updated
05/09/2018
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