Healthcare Provider Details

I. General information

NPI: 1609533561
Provider Name (Legal Business Name): SMILEKIDZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2021
Last Update Date: 11/25/2021
Certification Date: 11/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 HACKENSACK AVE STE 4
HACKENSACK NJ
07601-6334
US

IV. Provider business mailing address

42 BIRCH ST
ENGLEWOOD CLIFFS NJ
07632-1505
US

V. Phone/Fax

Practice location:
  • Phone: 201-500-8839
  • Fax:
Mailing address:
  • Phone: 201-403-1007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHELE HAPPY CINYEE LAU
Title or Position: MEMBER
Credential:
Phone: 201-403-1007