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General NPI Number Information
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NPI Number | 1376169094
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Entity Type | Organization
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Legal Business Name | COMMUNITY SMILES OF ELIZABETH PA
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Dates
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Enumeration Date | 06/18/2020
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Last Update Date | 06/30/2020
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Provider Practice Location Address
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Address Line | 1100 N BROAD ST
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City | HILLSIDE
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State | NJ
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Zip | 07205
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Country | US
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Telephone | 908-409-7100
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Fax | 908-409-5300
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Provider Business Mailing Address
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Address Line | 235 MEADOWBROOK RD
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City | ROBBINSVILLE
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State | NJ
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Zip | 08691
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Country | US
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Telephone | 732-318-7121
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Fax |
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Authorized Official
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Title or Position | COMPLIANCE OFFICER
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Name | SCHANZE ZAIDI
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Credential |
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Telephone | 609-403-0710
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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 |
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License Number State |
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