Healthcare Provider Details

I. General information

NPI: 1952026486
Provider Name (Legal Business Name): HOBOKEN SMILE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 15TH ST STE 3A
HOBOKEN NJ
07030-3429
US

IV. Provider business mailing address

333 15TH ST STE 3A
HOBOKEN NJ
07030-3429
US

V. Phone/Fax

Practice location:
  • Phone: 201-685-0171
  • Fax:
Mailing address:
  • Phone: 201-685-0171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RADHIKA KAPOOR
Title or Position: OWNER/PEDIATRIC DENTIST
Credential: DDS
Phone: 201-685-0171