Provider Demographics
NPI:1174036990
Name:GARDEN STATE HEALTHY SMILE PC
Entity Type:Organization
Organization Name:GARDEN STATE HEALTHY SMILE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAMIK
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSUFOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-728-7075
Mailing Address - Street 1:170 MORRIS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6660
Mailing Address - Country:US
Mailing Address - Phone:732-728-7075
Mailing Address - Fax:732-728-0337
Practice Address - Street 1:170 MORRIS AVE STE A
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6660
Practice Address - Country:US
Practice Address - Phone:732-728-7075
Practice Address - Fax:732-728-0337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty