| Lakewood Pediatric Dental Associates | |
|
1328 Route 9 South, Suite 11 & 12 Lakewood NJ 08701-5645 | |
| (732) 363-5558 | |
| (732) 363-5512 |
| Full Name | Lakewood Pediatric Dental Associates |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1328 Route 9 South, Suite 11 & 12, Lakewood, New Jersey |
| Authorized Official Name and Position | George J. Dierna (PRESIDENT) |
| Authorized Official Contact | 7323635558 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakewood Pediatric Dental Associates 1328 Route 9 South, Suite 11 & 12 Lakewood NJ 08701-5645 Ph: (732) 363-5558 | Lakewood Pediatric Dental Associates 1328 Route 9 South, Suite 11 & 12 Lakewood NJ 08701-5645 Ph: (732) 363-5558 |
| NPI Number | 1639155336 |
|---|---|
| Provider Enumeration Date | 12/15/2005 |
| Last Update Date | 09/13/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639155336 | NPI | - | NPPES |
| 0170682-01 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
| 1223P0221X | Dentist - Pediatric Dentistry | (New Jersey) | Secondary |
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