Provider Demographics
NPI:1093971681
Name:HEALTHY SMILES FAMILY DENTISTRY
Entity Type:Organization
Organization Name:HEALTHY SMILES FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOONI
Authorized Official - Middle Name:DILIP
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-260-4900
Mailing Address - Street 1:2151 ROUTE 38
Mailing Address - Street 2:UNIT 1003
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-4221
Mailing Address - Country:US
Mailing Address - Phone:909-260-4900
Mailing Address - Fax:
Practice Address - Street 1:1233 HADDONFIELD BERLIN RD
Practice Address - Street 2:UNIT 6
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4878
Practice Address - Country:US
Practice Address - Phone:856-768-8988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-02
Last Update Date:2008-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02366000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty