Provider Demographics
NPI:1437576733
Name:PRESTIGE ORAL SURGERY LLC
Entity Type:Organization
Organization Name:PRESTIGE ORAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:S
Authorized Official - Last Name:ERAKAT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:571-228-4139
Mailing Address - Street 1:3700 ROUTE 27
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-9610
Mailing Address - Country:US
Mailing Address - Phone:732-297-7000
Mailing Address - Fax:732-297-3638
Practice Address - Street 1:3700 ROUTE 27
Practice Address - Street 2:SUITE 103
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-9610
Practice Address - Country:US
Practice Address - Phone:732-297-7000
Practice Address - Fax:732-297-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02338701223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty