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General NPI Number Information
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NPI Number | 1821223868
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Entity Type | Organization
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Legal Business Name | LITTLE SMILES NEW JERSEY P.C.
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Dates
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Enumeration Date | 05/20/2009
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Last Update Date | 05/20/2009
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Provider Practice Location Address
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Address Line | 1 GATEWAY CTR SUITE 2600
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City | NEWARK
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State | NJ
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Zip | 07102-5310
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Country | US
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Telephone | 888-833-8441
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Fax | 888-330-4331
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Provider Business Mailing Address
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Address Line | 33533 W 12 MILE RD SUITE 150
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-3354
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Country | US
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Telephone | 888-833-8441
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Fax | 888-330-4331
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Authorized Official
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Title or Position | DENTAL DIRECTOR
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Name | ELLIOT P. SCHLANG
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Credential | DDS
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Telephone | 888-833-8441
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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 | 22DI02405500
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License Number State | NJ
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