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General NPI Number Information
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NPI Number | 1710151089
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Entity Type | Organization
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Legal Business Name | THE SMILE SPA OF NORTH JERSEY,LLC
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 05/10/2010
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Provider Practice Location Address
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Address Line | 251 GODWIN AVE
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City | MIDLAND PARK
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State | NJ
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Zip | 07432-1882
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Country | US
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Telephone | 201-445-2797
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Fax | 201-445-8340
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Provider Business Mailing Address
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Address Line | 251 GODWIN AVE
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City | MIDLAND PARK
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State | NJ
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Zip | 07432-1882
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Country | US
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Telephone | 201-445-2797
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Fax | 201-445-8340
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Authorized Official
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Title or Position | PROPRIETER
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Name | DR. DEBRA ROSENBLATT
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Credential | DDS
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Telephone | 201-445-2797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 2920508
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14180
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License Number State | NJ
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