Provider Demographics
NPI:1376169094
Name:COMMUNITY SMILES OF ELIZABETH PA
Entity Type:Organization
Organization Name:COMMUNITY SMILES OF ELIZABETH PA
Other - Org Name:COMMUNITY SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SCHANZE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAIDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-403-0710
Mailing Address - Street 1:235 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691
Mailing Address - Country:US
Mailing Address - Phone:732-318-7121
Mailing Address - Fax:
Practice Address - Street 1:1100 N BROAD ST
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205
Practice Address - Country:US
Practice Address - Phone:908-409-7100
Practice Address - Fax:908-409-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty