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General NPI Number Information
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NPI Number | 1871869750
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Entity Type | Organization
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Legal Business Name | MID JERSEY DENTAL
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Dates
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Enumeration Date | 03/26/2012
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Last Update Date | 03/26/2012
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Provider Practice Location Address
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Address Line | 1553 STATE HWY 27 SUITE 3400
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City | SOMERSET
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State | NJ
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Zip | 08873
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Country | US
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Telephone | 732-545-7650
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Fax | 732-846-0858
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Provider Business Mailing Address
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Address Line | 1553 STATE HWY 27 SUITE 3400
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City | SOMERSET
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State | NJ
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Zip | 08873
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Country | US
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Telephone | 732-545-7650
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Fax | 732-846-0858
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SCOTT DAVID LURIE
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Credential | D.M.D.
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Telephone | 732-545-7650
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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 | 22DIO1846503
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License Number State | NJ
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