Provider Demographics
NPI:1740415231
Name:GALLERY OF SMILES, LLC
Entity Type:Organization
Organization Name:GALLERY OF SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASS-BRUDZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:917-957-4638
Mailing Address - Street 1:220 RIDGEDALE AVE
Mailing Address - Street 2:SUITE B1
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1348
Mailing Address - Country:US
Mailing Address - Phone:973-295-6600
Mailing Address - Fax:973-295-6601
Practice Address - Street 1:220 RIDGEDALE AVE
Practice Address - Street 2:SUITE B1
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1348
Practice Address - Country:US
Practice Address - Phone:973-295-6600
Practice Address - Fax:973-295-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02297400261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental