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General NPI Number Information
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NPI Number | 1144435694
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Entity Type | Organization
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Legal Business Name | SMILECREATORS, P.A.
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 139 MAIN AVENUE
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City | CLIFTON
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State | NJ
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Zip | 07014
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Country | US
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Telephone | 973-471-8300
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Fax | 973-471-6662
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Provider Business Mailing Address
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Address Line | 139 MAIN AVENUE
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City | CLIFTON
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State | NJ
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Zip | 07014-1707
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Country | US
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Telephone | 973-471-8300
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Fax | 973-471-6662
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EVGENI GORIOUNOV
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Credential | D.D.S.
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Telephone | 973-471-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI02094100
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License Number State | NJ
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