LAKEWOOD PEDIATRIC DENTAL ASSOCIATES NPI 1639155336

NPI Information

LAKEWOOD PEDIATRIC DENTAL ASSOCIATES is a pediatric dentistry dentist in Lakewood, NJ. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. LAKEWOOD PEDIATRIC DENTAL ASSOCIATES NPI is 1639155336. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

1328 ROUTE 9 SOUTH, SUITE 11 & 12
LAKEWOOD, NJ
ZIP 08701-645
Phone: (732) 363-5558
Fax: (732) 363-5512

The provider's authorized official is George J. Dierna .
The authorized official title is President and has the following contact phone number (732) 363-5558.

The CLIA number assigned to this NPI record is 31D2285874 - other - sud program op & iop with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/15/2005 and was last updated on 9/13/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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