Healthcare Provider Details

I. General information

NPI: 1790608743
Provider Name (Legal Business Name): OLIVE AND IVORY DENTAL LOUNGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 CLYDE RD STE 103
SOMERSET NJ
08873-5041
US

IV. Provider business mailing address

142 N 6TH AVE UNIT 1
MANVILLE NJ
08835-1208
US

V. Phone/Fax

Practice location:
  • Phone: 516-244-1024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NAWAL SHAIKH
Title or Position: OWNER
Credential: DDS
Phone: 516-244-1024