Provider Demographics
NPI:1558739433
Name:SMILE BY DESIGN
Entity Type:Organization
Organization Name:SMILE BY DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-343-4483
Mailing Address - Street 1:120 STATE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-8911
Mailing Address - Country:US
Mailing Address - Phone:201-343-4483
Mailing Address - Fax:
Practice Address - Street 1:120 STATE ST
Practice Address - Street 2:2ND FLOOR SUITE 3
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-8910
Practice Address - Country:US
Practice Address - Phone:201-343-4483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ14077261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental