NPIMap

Organization Active NPI

Premier Family Dental PC

  • Dentist
  • Clifton, NJ
National Provider Identifier
1962847020
Registry record updated May 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DI0227391 Issued in NJ
Legal business name
PREMIER FAMILY DENTAL PC
Practice address
520 Clifton Ave Ste 4
4
Clifton, NJ 07011-3247
Phone
(973) 772-4222
Fax
(973) 772-7652
NPI assigned
May 2, 2013
Last updated
May 2, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2013

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

Authorized official

Name
Mrs. Gira Rathod
Title
Office Manager
Phone
(973) 772-4222

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X DI0227391 NJ Primary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X DI2443200 NJ

Addresses

Primary practice location

520 Clifton Ave Ste 4
4
Clifton, NJ 07011-3247

Mailing address

520 Clifton Ave Ste 4
4
Clifton, NJ 07011-3247
Phone (973) 772-4222

Other identifiers 2

IdentifierTypeStateIssuer
0227391MedicaidNJ
0255891MedicaidNJ

National Provider Directory

National Provider Directory

Locations

520 Clifton Ave
Ste 4
Clifton, NJ 07011
Phone (973) 772-4222

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1367452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367452800000",
    "number": "1962847020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 CLIFTON AVE STE 4",
            "address_2": "4",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070113247",
            "telephone_number": "973-772-4222",
            "fax_number": "973-772-7652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 CLIFTON AVE STE 4",
            "address_2": "4",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070113247",
            "telephone_number": "973-772-4222",
            "fax_number": "973-772-7652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER FAMILY DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-02",
        "last_updated": "2013-05-02",
        "status": "A",
        "authorized_official_last_name": "RATHOD",
        "authorized_official_first_name": "GIRA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "973-772-4222",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NJ",
            "license": "DI0227391",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NJ",
            "license": "DI2443200",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0227391",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0255891",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clifton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2013; 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.