Provider Demographics
NPI:1710109467
Name:SWEET SMILE ORTHODONTICS
Entity Type:Organization
Organization Name:SWEET SMILE ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:SHII CHYUAN
Authorized Official - Last Name:TYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:914-830-8612
Mailing Address - Street 1:20 LINCOLN PL APT C
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-4050
Mailing Address - Country:US
Mailing Address - Phone:732-658-3294
Mailing Address - Fax:
Practice Address - Street 1:666 PLAINSBORO RD
Practice Address - Street 2:SUITE 1181
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-3030
Practice Address - Country:US
Practice Address - Phone:914-830-8612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI0228301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty