MEDICARE: AZUREAN 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1336847581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZUREAN LLC

Provider Business Mailing Address
First Line	:	1914 LINCOLN HWY STE B
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08817-3250
Country	:	US
Telephone Number	:	732-724-0805
Fax Number	:	732-724-0878

Provider Business Practice Location Address
First Line	:	1914 LINCOLN HWY STE B
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08817-3250
Country	:	US
Telephone Number	:	732-724-0805
Fax Number	:	732-724-0878

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NIKITAS LAMBRINOS
Credential	:	DDS
Telephone Number	:	732-724-0805

Provider Enumeration Date	:	02/17/2023
Last Update Date	:	02/17/2023

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Directions to “AZUREAN LLC ” Practice Location

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