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General NPI Number Information
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NPI Number | 1063263879
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Entity Type | Organization
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Legal Business Name | SMILE GARDEN PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 03/29/2024
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Last Update Date | 03/29/2024
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Provider Practice Location Address
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Address Line | 19 WILLS WAY
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City | PISCATAWAY
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State | NJ
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Zip | 08854-3770
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Country | US
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Telephone | 733-732-2166
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Fax |
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Provider Business Mailing Address
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Address Line | 19 WILLS WAY
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City | PISCATAWAY
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State | NJ
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Zip | 08854-3770
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | LISA LIAN
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Credential |
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Telephone | 732-733-2166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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