Organization
LAKEWOOD PEDIATRIC DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE J. DIERNA D.D.S. (PRESIDENT)
(732) 363-5558
Entity
Organization
Contact information
Practice address
1328 ROUTE 9 SOUTH, SUITE 11 & 12, LAKEWOOD, NJ 08701-5645
(732) 363-5558
(732) 363-5512
Mailing address
1328 ROUTE 9 SOUTH, SUITE 11 & 12, LAKEWOOD, NJ 08701-5645
(732) 363-5558
(732) 363-5512
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
—
NJ
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0170682-01
—
NJ
Enumeration date
12/15/2005
Last updated
09/13/2011
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