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General NPI Number Information
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NPI Number | 1144798307
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Entity Type | Organization
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Legal Business Name | THE SMILIST DENTAL OF NEW JERSEY II, LLC
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Dates
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Enumeration Date | 11/06/2018
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Last Update Date | 11/06/2018
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Provider Practice Location Address
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Address Line | 470 CLIFTON AVE
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City | CLIFTON
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State | NJ
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Zip | 07011-3262
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Country | US
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Telephone | 862-304-4009
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Fax |
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Provider Business Mailing Address
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Address Line | 40 CUTTERMILL RD STE 500
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City | GREAT NECK
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State | NY
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Zip | 11021-3213
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Country | US
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Telephone | 516-441-2173
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | WALTER D HOSP
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Credential |
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Telephone | 516-441-2173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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