Healthcare Provider Details

I. General information

NPI: 1609228873
Provider Name (Legal Business Name): HOBOKEN SMILE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33-41 NEWARK ST STE 2A
HOBOKEN NJ
07030-5620
US

IV. Provider business mailing address

33-41 NEWARK ST SUITE 2A
HOBOKEN NJ
07030-5627
US

V. Phone/Fax

Practice location:
  • Phone: 201-683-7018
  • Fax:
Mailing address:
  • Phone: 201-683-7018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number22DI02541000
License Number StateNJ

VIII. Authorized Official

Name: DR. RADHIKA KAPOOR
Title or Position: PEDIATRIC DENTIST/OWNER
Credential: DDS
Phone: 201-683-7018