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General NPI Number Information
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NPI Number | 1093910143
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Entity Type | Organization
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Legal Business Name | SMILE DENTAL OFFICE, P.C.
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 02/15/2012
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Provider Practice Location Address
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Address Line | 1152 CLINTON AVENUE
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City | IRVINGTON
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State | NJ
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Zip | 07111
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Country | US
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Telephone | 973-372-5640
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Fax | 973-371-7697
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Provider Business Mailing Address
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Address Line | 1152 CLINTON AVENUE
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City | IRVINGTON
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State | NJ
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Zip | 07111
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Country | US
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Telephone | 973-372-5640
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Fax | 973-371-7697
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | LESLIE TORRES
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Credential |
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Telephone | 973-372-5640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 19126
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License Number State | NJ
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