Provider Demographics
NPI:1699806547
Name:PREMIER DENTAL OF NEW JERSEY, P.C.
Entity Type:Organization
Organization Name:PREMIER DENTAL OF NEW JERSEY, P.C.
Other - Org Name:VITRUVIAN DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HONGSOK
Authorized Official - Middle Name:
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-746-6003
Mailing Address - Street 1:577 CHESTNUT RIDGE RD
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-8409
Mailing Address - Country:US
Mailing Address - Phone:201-746-6003
Mailing Address - Fax:201-746-6005
Practice Address - Street 1:577 CHESTNUT RIDGE RD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8409
Practice Address - Country:US
Practice Address - Phone:201-746-6003
Practice Address - Fax:201-746-6005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ210021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty