Healthcare Provider Details

I. General information

NPI: 1962193128
Provider Name (Legal Business Name): SMILING MOLAR DENTAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 PARK AVE STE 6C
PLAINFIELD NJ
07060-3015
US

IV. Provider business mailing address

235 MEADOWBROOK RD
ROBBINSVILLE NJ
08691-2502
US

V. Phone/Fax

Practice location:
  • Phone: 908-633-4200
  • Fax:
Mailing address:
  • Phone: 908-633-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. NEETU BHANUSHALI
Title or Position: OWNER
Credential: DDS
Phone: 908-633-4200