MEDICARE: AMAZING SMILES DENTISTRY FOR CHILDREN, PA

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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1558831370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMAZING SMILES DENTISTRY FOR CHILDREN, PA

Provider Business Mailing Address
First Line	:	160 MOUNTAIN AVE STE 101
Second Line	:
City	:	HACKETTSTOWN
State	:	NJ
Zip	:	07840-2324
Country	:	US
Telephone Number	:	908-269-8056
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 MOUNTAIN AVE STE 101
Second Line	:
City	:	HACKETTSTOWN
State	:	NJ
Zip	:	07840-2324
Country	:	US
Telephone Number	:	646-247-7635
Fax Number	:

Authorized Official
Title or Position	:	PEDIATRIC DENTIST
Name	:	DR. NATARICA CHEVALA FRANKLIN
Credential	:	D.D.S.
Telephone Number	:	908-269-8056

Provider Enumeration Date	:	12/05/2018
Last Update Date	:	09/03/2019

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