Provider Demographics
NPI:1871919779
Name:MOUNTAIN LAKES PREMIER DENTAL , LLC
Entity type:Organization
Organization Name:MOUNTAIN LAKES PREMIER DENTAL , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NESRINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BESTANDJI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-263-2770
Mailing Address - Street 1:420 BOULEVARD
Mailing Address - Street 2:SUITE#102
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1742
Mailing Address - Country:US
Mailing Address - Phone:973-263-2770
Mailing Address - Fax:973-263-1291
Practice Address - Street 1:420 BOULEVARD
Practice Address - Street 2:SUITE#102
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1742
Practice Address - Country:US
Practice Address - Phone:973-263-2770
Practice Address - Fax:973-263-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-15
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02466900122300000X
NJ22DI02456600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty