Provider Demographics
NPI:1871869750
Name:MID JERSEY DENTAL
Entity type:Organization
Organization Name:MID JERSEY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LURIE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-545-7650
Mailing Address - Street 1:1553 STATE HWY 27
Mailing Address - Street 2:SUITE 3400
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873
Mailing Address - Country:US
Mailing Address - Phone:732-545-7650
Mailing Address - Fax:732-846-0858
Practice Address - Street 1:1553 STATE HWY 27
Practice Address - Street 2:SUITE 3400
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-545-7650
Practice Address - Fax:732-846-0858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO18465031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty