MEDICARE: ADABELLA SMILE P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1396593505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADABELLA SMILE P.A.

Provider Business Mailing Address
First Line	:	126 HOPPER AVE
Second Line	:
City	:	NUTLEY
State	:	NJ
Zip	:	07110-2576
Country	:	US
Telephone Number	:	973-652-3093
Fax Number	:

Provider Business Practice Location Address
First Line	:	570 W SIDE AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304-1741
Country	:	US
Telephone Number	:	973-652-3093
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARIAM BESHARA
Credential	:	DMD
Telephone Number	:	973-652-3093

Provider Enumeration Date	:	05/11/2024
Last Update Date	:	05/15/2024

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