Healthcare Provider Details

I. General information

NPI: 1588572986
Provider Name (Legal Business Name): ORTHO DENTAL SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 BROAD ST STE 207
CLIFTON NJ
07013-3346
US

IV. Provider business mailing address

1135 BROAD ST STE 207
CLIFTON NJ
07013-3346
US

V. Phone/Fax

Practice location:
  • Phone: 973-338-1383
  • Fax:
Mailing address:
  • Phone: 973-338-1383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. HASSAM SULTAN
Title or Position: OWNER
Credential: DMD,MS,FAAPD
Phone: 860-235-2063