Provider Demographics
NPI:1760855969
Name:NEW JERSEY SMILES LLC
Entity Type:Organization
Organization Name:NEW JERSEY SMILES LLC
Other - Org Name:NJ SMILES OF UNION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARDEEK
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:908-686-0060
Mailing Address - Street 1:372 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-9401
Mailing Address - Country:US
Mailing Address - Phone:908-686-0060
Mailing Address - Fax:908-756-5806
Practice Address - Street 1:88 JERSEY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3526
Practice Address - Country:US
Practice Address - Phone:908-686-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22917001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2291700OtherLICENSE