| Lake Family Dentistry | |
|
296 Lake Ave Colonia NJ 07067-1201 | |
| (732) 388-2822 | |
| (732) 388-3115 |
| Full Name | Lake Family Dentistry |
|---|---|
| Speciality | Clinic/Center |
| Location | 296 Lake Ave, Colonia, New Jersey |
| Authorized Official Name and Position | Danish Qadri (PRESIDENT) |
| Authorized Official Contact | 7323882822 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Family Dentistry 296 Lake Ave Colonia NJ 07067-1201 Ph: (732) 388-2822 | Lake Family Dentistry 296 Lake Ave Colonia NJ 07067-1201 Ph: (732) 388-2822 |
| NPI Number | 1275804312 |
|---|---|
| Provider Enumeration Date | 01/21/2012 |
| Last Update Date | 01/26/2015 |
| Medicare PECOS PAC ID | 3870810526 |
|---|---|
| Medicare Enrollment ID | O20150318000773 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275804312 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 22DI02351300 (New Jersey) | Primary |
| Provider Name | Danish Qadri |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1376739045 PECOS PAC ID: 4789901430 Enrollment ID: I20150318000879 |
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