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General NPI Number Information
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NPI Number | 1225059330
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Entity Type | Organization
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Legal Business Name | SMILE CREATIONS PA
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 07/07/2008
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Provider Practice Location Address
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Address Line | 630 S BREWSTER RD SUITE A-2
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City | VINELAND
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State | NJ
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Zip | 08361-7801
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Country | US
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Telephone | 856-692-0060
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Fax | 856-692-0382
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Provider Business Mailing Address
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Address Line | 630 S BREWSTER RD SUITE A-2
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City | VINELAND
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State | NJ
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Zip | 08361-7801
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Country | US
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Telephone | 856-692-0060
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Fax | 856-692-0382
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. NICHOLAS BENCIE
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Credential | DMD
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Telephone | 856-692-0060
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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 | 22D101649200
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License Number State | NJ
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