Healthcare Provider Details

I. General information

NPI: 1063999506
Provider Name (Legal Business Name): TENDER SMILES OF ROSELLE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N WOOD AVE
LINDEN NJ
07036-4039
US

IV. Provider business mailing address

1330 HOW LN
NORTH BRUNSWICK NJ
08902-1702
US

V. Phone/Fax

Practice location:
  • Phone: 908-245-5556
  • Fax:
Mailing address:
  • Phone: 732-249-1010
  • Fax: 732-220-0177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MAXIM SULLA
Title or Position: OWNER
Credential: DDS
Phone: 732-249-1010