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General NPI Number Information
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NPI Number | 1629089909
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Entity Type | Organization
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Legal Business Name | SMILE CENTRAL DENTAL PC
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 03/10/2016
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Provider Practice Location Address
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Address Line | 140 MARKET STREET 3RD FLOOR
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City | PATERSON
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State | NJ
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Zip | 07505
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Country | US
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Telephone | 973-742-4200
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Fax | 973-742-4997
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Provider Business Mailing Address
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Address Line | 140 MARKET STREET 3RD FLOOR
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City | PATERSON
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State | NJ
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Zip | 07505
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Country | US
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Telephone | 973-742-4200
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Fax | 973-742-4997
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT GRUNSTEIN
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Credential | DMD
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Telephone | 973-742-4200
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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 | DI21533
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License Number State | NJ
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