Provider Demographics
NPI:1275554123
Name:SOMERSET PEDIATRIC DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:SOMERSET PEDIATRIC DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-568-0233
Mailing Address - Street 1:33 CLYDE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5032
Mailing Address - Country:US
Mailing Address - Phone:732-568-0233
Mailing Address - Fax:732-568-0213
Practice Address - Street 1:33 CLYDE RD STE 104
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5032
Practice Address - Country:US
Practice Address - Phone:732-568-0233
Practice Address - Fax:732-568-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0205511223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty