MEDICARE: SMILE4EVER DENTISTRY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1235092040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE4EVER DENTISTRY PC

Provider Business Mailing Address
First Line	:	33 LINCOLN AVE
Second Line	:
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-2167
Country	:	US
Telephone Number	:	201-933-0200
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 LINCOLN AVE
Second Line	:
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-2167
Country	:	US
Telephone Number	:	201-933-0200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SEHOON MOON
Credential	:	DDS
Telephone Number	:	201-933-0200

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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