Provider Demographics
NPI:1275937872
Name:SUPER SMILES DENTISTRY FOR CHILDREN, PC
Entity Type:Organization
Organization Name:SUPER SMILES DENTISTRY FOR CHILDREN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PACTOVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-880-1500
Mailing Address - Street 1:1221 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-1245
Mailing Address - Country:US
Mailing Address - Phone:609-880-1500
Mailing Address - Fax:609-880-0091
Practice Address - Street 1:77 GARLAND LN
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-3011
Practice Address - Country:US
Practice Address - Phone:609-880-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022925001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty