Healthcare Provider Details

I. General information

NPI: 1447507785
Provider Name (Legal Business Name): SMILE DESIGN SPECIALIST, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 BELLEVILLE TURNPIKE SUITE 3-B
NORTH ARLINGTON NJ
07031-6460
US

IV. Provider business mailing address

312 BELLEVILLE TURNPIKE SUITE 3-B
NORTH ARLINGTON NJ
07031-6460
US

V. Phone/Fax

Practice location:
  • Phone: 201-991-1228
  • Fax: 201-991-7227
Mailing address:
  • Phone: 201-991-1228
  • Fax: 201-991-7227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD EKSTEIN
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 201-991-1228