| Premium Dentistry | |
|
6 W Spruce St Lakewood NJ 08701-5007 | |
| (732) 364-5100 | |
| (201) 927-3474 |
| Full Name | Premium Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 6 W Spruce St, Lakewood, New Jersey |
| Authorized Official Name and Position | Andre Shivrattan (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 3475795159 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Premium Dentistry 6 W Spruce St Lakewood NJ 08701-5007 Ph: (732) 364-5100 | Premium Dentistry 6 W Spruce St Lakewood NJ 08701-5007 Ph: (732) 364-5100 |
| NPI Number | 1528557063 |
|---|---|
| Provider Enumeration Date | 05/09/2018 |
| Last Update Date | 05/09/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528557063 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 22DI01842800 (New Jersey) | Primary |
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