Organization
PREMIER FAMILY DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GIRA RATHOD (OFFICE MANAGER)
(973) 772-4222
Entity
Organization
Contact information
Practice address
520 CLIFTON AVE STE 4, 4, CLIFTON, NJ 07011-3247
(973) 772-4222
(973) 772-7652
Mailing address
520 CLIFTON AVE STE 4, 4, CLIFTON, NJ 07011-3247
(973) 772-4222
(973) 772-7652
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DI0227391
NJ
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DI2443200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0227391
—
NJ
05
—
0255891
—
NJ
Enumeration date
05/02/2013
Last updated
05/02/2013
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