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General NPI Number Information
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NPI Number | 1154783512
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Entity Type | Organization
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Legal Business Name | EVERSMILE DENTAL, LLC
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Dates
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Enumeration Date | 03/24/2016
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Last Update Date | 03/24/2016
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Provider Practice Location Address
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Address Line | 479 N MIDLAND AVE
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City | SADDLE BROOK
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State | NJ
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Zip | 07663-5597
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Country | US
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Telephone | 201-773-3992
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Fax |
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Provider Business Mailing Address
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Address Line | 479 N MIDLAND AVE
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City | SADDLE BROOK
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State | NJ
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Zip | 07663-5597
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Country | US
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Telephone | 201-773-3992
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MARYZ Y ESTEDRAK
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Credential | DDS
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Telephone | 201-773-3992
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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 | 22DI02622100
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License Number State | NJ
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