Provider Demographics
NPI:1073143723
Name:LASTING SMILES OF WHITEHOUSE STATION LLC
Entity Type:Organization
Organization Name:LASTING SMILES OF WHITEHOUSE STATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMISH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DENTIST
Authorized Official - Phone:267-221-9898
Mailing Address - Street 1:531 US HIGHWAY 22 E
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE STATION
Mailing Address - State:NJ
Mailing Address - Zip Code:08889-3695
Mailing Address - Country:US
Mailing Address - Phone:908-534-4001
Mailing Address - Fax:908-534-2937
Practice Address - Street 1:531 US HIGHWAY 22 E
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE STATION
Practice Address - State:NJ
Practice Address - Zip Code:08889-3695
Practice Address - Country:US
Practice Address - Phone:908-534-4001
Practice Address - Fax:908-534-2937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty