MEDICARE: A&A DENTAL, 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	:	1376178335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A&A DENTAL, LLC

Provider Business Mailing Address
First Line	:	719 N BEERS ST STE 2C
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1523
Country	:	US
Telephone Number	:	732-264-5933
Fax Number	:

Provider Business Practice Location Address
First Line	:	719 N BEERS ST STE 2C
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1523
Country	:	US
Telephone Number	:	732-264-5933
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ARASH BASERI
Credential	:
Telephone Number	:	732-264-5933

Provider Enumeration Date	:	03/10/2020
Last Update Date	:	03/10/2020

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