Provider Demographics
NPI:1609352012
Name:CRYSTAL SMILES, LLC
Entity Type:Organization
Organization Name:CRYSTAL SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TEJAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DARJI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-257-4444
Mailing Address - Street 1:65 RUES LN
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4240
Mailing Address - Country:US
Mailing Address - Phone:732-257-4444
Mailing Address - Fax:732-257-9799
Practice Address - Street 1:65 RUES LN
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4240
Practice Address - Country:US
Practice Address - Phone:732-257-4444
Practice Address - Fax:732-257-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty