Healthcare Provider Details

I. General information

NPI: 1568375608
Provider Name (Legal Business Name): BOOM SMILES SECAUCUS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 MEADOWLANDS PKWY
SECAUCUS NJ
07094-1804
US

IV. Provider business mailing address

333 MEADOWLANDS PKWY
SECAUCUS NJ
07094-1804
US

V. Phone/Fax

Practice location:
  • Phone: 201-864-2600
  • Fax:
Mailing address:
  • Phone: 201-864-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHERRI FETHERMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 973-868-4131