MEDICARE: PREMIER DENTAL ARTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	22DI02245700	NJ

General Provider Information

NPI Number	:	1184066607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER DENTAL ARTS, LLC

Provider Business Mailing Address
First Line	:	3800 QUAKERBRIDGE RD
Second Line	:	SUITE 1
City	:	HAMILTON
State	:	NJ
Zip	:	08619-1010
Country	:	US
Telephone Number	:	609-890-1888
Fax Number	:	609-890-4040

Provider Business Practice Location Address
First Line	:	3800 QUAKERBRIDGE RD
Second Line	:	SUITE 1
City	:	HAMILTON
State	:	NJ
Zip	:	08619-1010
Country	:	US
Telephone Number	:	609-890-1888
Fax Number	:	609-890-4040

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHIAWEI WU
Credential	:	DDS
Telephone Number	:	609-890-1888

Provider Enumeration Date	:	07/25/2013
Last Update Date	:	07/25/2013

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