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General NPI Number Information
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NPI Number | 1790608743
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Entity Type | Organization
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Legal Business Name | OLIVE AND IVORY DENTAL LOUNGE LLC
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Dates
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Enumeration Date | 08/04/2026
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Last Update Date | 08/04/2026
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Provider Practice Location Address
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Address Line | 17 CLYDE RD STE 103
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City | SOMERSET
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State | NJ
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Zip | 08873-5041
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Country | US
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Telephone | 516-244-1024
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Fax |
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Provider Business Mailing Address
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Address Line | 142 N 6TH AVE UNIT 1
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City | MANVILLE
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State | NJ
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Zip | 08835-1208
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NAWAL SHAIKH
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Credential | DDS
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Telephone | 516-244-1024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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