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General NPI Number Information
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NPI Number | 1487188686
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Entity Type | Organization
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Legal Business Name | SMILE WORKS DENTAL CENTER PA.
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Dates
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Enumeration Date | 04/13/2017
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Last Update Date | 04/13/2017
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Provider Practice Location Address
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Address Line | 101 CRAWFORD CORNER ROAD IN BELLWORKS BUILDING SUITE 1109
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City | HOLMDEL
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State | NJ
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Zip | 07733
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Country | US
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Telephone | 732-332-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 2515 HWY 516 2ND FLOOR
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City | OLD BRIDGE
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State | NJ
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Zip | 08857
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Country | US
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Telephone | 732-332-1500
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW S WHITEMAN
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Credential | DDS
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Telephone | 732-673-6634
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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 | DJO19480
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License Number State | NJ
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