NPIMap

Organization Active NPI

Lakewood Pediatric Dental Associates

  • Pediatric Dentistry
  • Lakewood, NJ
National Provider Identifier
1639155336
Registry record updated Sep 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
LAKEWOOD PEDIATRIC DENTAL ASSOCIATES
Practice address
1328 Route 9 South, Suite 11 & 12
Lakewood, NJ 08701-5645
Phone
(732) 363-5558
Fax
(732) 363-5512
NPI assigned
Dec 15, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
George J. Dierna, D.D.S.NPI 1598727455
Title
President
Phone
(732) 363-5558

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X Primary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X NJ

Addresses

Primary practice location

1328 Route 9 South, Suite 11 & 12
Lakewood, NJ 08701-5645

Mailing address

1328 Route 9 South, Suite 11 & 12
Lakewood, NJ 08701-5645
Phone (732) 363-5558

Other identifiers 1

IdentifierTypeStateIssuer
0170682-01MedicaidNJ

National Provider Directory

National Provider Directory

Locations

1328 Route 9
Ste 11
Lakewood, NJ 08701
Phone (732) 363-5558

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315872000000",
    "number": "1639155336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1328 ROUTE 9 SOUTH, SUITE 11 & 12",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087015645",
            "telephone_number": "732-363-5558",
            "fax_number": "732-363-5512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1328 ROUTE 9 SOUTH, SUITE 11 & 12",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087015645",
            "telephone_number": "732-363-5558",
            "fax_number": "732-363-5512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD PEDIATRIC DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-15",
        "last_updated": "2011-09-13",
        "status": "A",
        "authorized_official_last_name": "DIERNA",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-363-5558",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0170682-01",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.