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General NPI Number Information
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NPI Number | 1265110969
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Entity Type | Organization
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Legal Business Name | SICKLERVILLE SMILES
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 423 SICKLERVILLE RD
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-2555
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Country | US
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Telephone | 856-728-9200
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Fax | 856-728-4550
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Provider Business Mailing Address
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Address Line | 423 SICKLERVILLE RD
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-2555
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Country | US
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Telephone | 856-728-9200
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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. ARYAM MODESTO
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Credential | DMD
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Telephone | 201-709-2802
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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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