Provider Demographics
NPI:1265000673
Name:TENDER SMILES OF OCEAN PA
Entity Type:Organization
Organization Name:TENDER SMILES OF OCEAN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-249-1010
Mailing Address - Street 1:1330 HOW LN
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1702
Mailing Address - Country:US
Mailing Address - Phone:732-249-1100
Mailing Address - Fax:
Practice Address - Street 1:105 BERKELEY AVE
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4707
Practice Address - Country:US
Practice Address - Phone:732-774-7008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-12
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty