Provider Demographics
NPI:1699012781
Name:NUSMILEFAMILYDENTISTRY,LLC
Entity Type:Organization
Organization Name:NUSMILEFAMILYDENTISTRY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SUMANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUDDANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-462-0050
Mailing Address - Street 1:222 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2619
Mailing Address - Country:US
Mailing Address - Phone:732-462-0050
Mailing Address - Fax:732-308-0757
Practice Address - Street 1:222 SOUTH ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2619
Practice Address - Country:US
Practice Address - Phone:732-462-0050
Practice Address - Fax:732-308-0757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty