Provider Demographics
NPI:1174804694
Name:THE LASER DENTAL GROUP OF WESTFIELD, LLC
Entity type:Organization
Organization Name:THE LASER DENTAL GROUP OF WESTFIELD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-232-2136
Mailing Address - Street 1:581 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-3300
Mailing Address - Country:US
Mailing Address - Phone:908-232-2136
Mailing Address - Fax:
Practice Address - Street 1:581 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-3300
Practice Address - Country:US
Practice Address - Phone:908-232-2136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1131700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty