Premium Dentistry

NPI #1528557063 in Lakewood, New Jersey

Provider Information

NPI Number: 1528557063
Entity Type: Organization
Organization Name: Premium Dentistry
Subpart: Yes (part of a larger organization)
Parent Organization: DENTAL ASSOCIATES OF LAKEWOOD
Primary Specialty: Dentist
Enumeration Date: May 9, 2018
Last Updated: May 9, 2018

Practice Location

Address: 6 W SPRUCE ST
City: Lakewood
State: New Jersey
ZIP Code: 08701-5007
Phone: (732) 364-5100

Authorized Official

Name: ANDRE SHIVRATTAN
Title: CREDENTIALING SPECIALIST
Phone: (347) 579-5159

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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