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General NPI Number Information
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NPI Number | 1235862889
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Entity Type | Organization
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Legal Business Name | BRILLIANT SMILES PEDIATRIC DENTISTRY, LLC
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Dates
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Enumeration Date | 07/01/2022
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Last Update Date | 07/01/2022
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Provider Practice Location Address
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Address Line | 237 HALSEY ST
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City | NEWARK
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State | NJ
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Zip | 07102
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Country | US
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Telephone | 862-955-2285
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Fax | 862-367-8219
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Provider Business Mailing Address
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Address Line | 243 HALSEY ST
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City | NEWARK
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State | NJ
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Zip | 07102-3746
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Country | US
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Telephone | 862-955-2285
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Fax |
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Authorized Official
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Title or Position | OWNER - PEDIATRIC DENTIST
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Name | DR. SUFFIYAH WEBB
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Credential | DDS
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Telephone | 862-955-2285
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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 |
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License Number State |
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