Provider Demographics
NPI:1144798307
Name:THE SMILIST DENTAL OF NEW JERSEY II, LLC
Entity Type:Organization
Organization Name:THE SMILIST DENTAL OF NEW JERSEY II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOSP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-441-2173
Mailing Address - Street 1:40 CUTTERMILL RD STE 500
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3213
Mailing Address - Country:US
Mailing Address - Phone:516-441-2173
Mailing Address - Fax:
Practice Address - Street 1:470 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-3262
Practice Address - Country:US
Practice Address - Phone:862-304-4009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental