Provider Demographics
NPI:1760025894
Name:LAKEWOOD DENTAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:LAKEWOOD DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-422-3647
Mailing Address - Street 1:838 RIVER AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5279
Mailing Address - Country:US
Mailing Address - Phone:732-363-4477
Mailing Address - Fax:732-905-7085
Practice Address - Street 1:838 RIVER AVE STE 1
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5279
Practice Address - Country:US
Practice Address - Phone:732-363-4477
Practice Address - Fax:732-905-7085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2019-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty