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General NPI Number Information
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NPI Number | 1972989184
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Entity Type | Organization
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Legal Business Name | ISMILE DENTAL ARTS, PC
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Dates
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Enumeration Date | 08/11/2015
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Last Update Date | 08/11/2015
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Provider Practice Location Address
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Address Line | 368 BERLIN CROSS KEYS RD
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City | WILLIAMSTOWN
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State | NJ
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Zip | 08094
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Country | US
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Telephone | 856-287-1158
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Fax |
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Provider Business Mailing Address
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Address Line | 43 MULLEN DR
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-1300
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Country | US
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Telephone | 856-287-1158
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WAEL M KASSEM
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Credential | DMD
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Telephone | 856-287-1158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 22DI02376800
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License Number State | NJ
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