Provider Demographics
NPI:1265847586
Name:SMILE CARE DENTAL GROUP
Entity Type:Organization
Organization Name:SMILE CARE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WESAM
Authorized Official - Middle Name:
Authorized Official - Last Name:EL SHAFEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:914-433-6874
Mailing Address - Street 1:735 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1801
Mailing Address - Country:US
Mailing Address - Phone:973-778-7500
Mailing Address - Fax:973-778-7501
Practice Address - Street 1:735 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1801
Practice Address - Country:US
Practice Address - Phone:973-778-7500
Practice Address - Fax:973-778-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02507600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty