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General NPI Number Information
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NPI Number | 1265847586
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Entity Type | Organization
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Legal Business Name | SMILE CARE DENTAL GROUP
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 06/25/2014
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Provider Practice Location Address
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Address Line | 735 CLIFTON AVE
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City | CLIFTON
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State | NJ
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Zip | 07013-1801
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Country | US
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Telephone | 973-778-7500
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Fax | 973-778-7501
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Provider Business Mailing Address
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Address Line | 735 CLIFTON AVE
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City | CLIFTON
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State | NJ
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Zip | 07013-1801
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Country | US
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Telephone | 973-778-7500
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Fax | 973-778-7501
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Authorized Official
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Title or Position | OWNER
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Name | DR. WESAM EL SHAFEE
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Credential | DMD
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Telephone | 914-433-6874
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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 | 22DI02507600
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License Number State | NJ
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