Provider Demographics
NPI:1659623981
Name:DIAMOND DENTAL STUDIO
Entity Type:Organization
Organization Name:DIAMOND DENTAL STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:SATWAH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-422-7777
Mailing Address - Street 1:3086 STATE ROUTE 27
Mailing Address - Street 2:SUITE 12
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3086 STATE ROUTE 27
Practice Address - Street 2:SUITE 12
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1658
Practice Address - Country:US
Practice Address - Phone:732-422-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02358900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty