Provider Demographics
NPI:1487188686
Name:SMILE WORKS DENTAL CENTER PA.
Entity Type:Organization
Organization Name:SMILE WORKS DENTAL CENTER PA.
Other - Org Name:SMILE WORKS DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHITEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-673-6634
Mailing Address - Street 1:2515 HWY 516 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857
Mailing Address - Country:US
Mailing Address - Phone:732-332-1500
Mailing Address - Fax:
Practice Address - Street 1:101 CRAWFORD CORNER ROAD IN BELLWORKS BUILDING
Practice Address - Street 2:SUITE 1109
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733
Practice Address - Country:US
Practice Address - Phone:732-332-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDJO19480122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty