Healthcare Provider Details

I. General information

NPI: 1124486899
Provider Name (Legal Business Name): SMILES DENTAL CARE OF NEW JERSEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 US HIGHWAY 46 SUITE 211
PARSIPPANY NJ
07054-2142
US

IV. Provider business mailing address

290 MADISON AVE
MORRISTOWN NJ
07960-7400
US

V. Phone/Fax

Practice location:
  • Phone: 973-334-2255
  • Fax: 973-334-2291
Mailing address:
  • Phone: 973-539-7575
  • Fax: 973-539-6850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02068909
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02538400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number22DI02068909
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22DI01650500
License Number StateNJ

VIII. Authorized Official

Name: DR. PRIYA DUGGAL
Title or Position: OWNER
Credential: D.M.D.
Phone: 973-539-7575