Provider Demographics
NPI:1609314962
Name:MIDJERSEY SMILES LLC
Entity Type:Organization
Organization Name:MIDJERSEY SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KUMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-727-0895
Mailing Address - Street 1:1447 ROUTE 18
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:732-727-0895
Mailing Address - Fax:
Practice Address - Street 1:1447 ROUTE 18
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857
Practice Address - Country:US
Practice Address - Phone:732-727-0895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02406100122300000X
NJ22DI02383502122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1750616389OtherHEALTH CARE PROVIDER
NJ1053577833OtherHEALTH CARE PROVIDER