Provider Demographics
NPI:1821387796
Name:THE SMILE CENTER OF CREAM RIDGE, PA
Entity Type:Organization
Organization Name:THE SMILE CENTER OF CREAM RIDGE, PA
Other - Org Name:THE SMILE CENTER OF WRIGHTSTOWN
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-758-2244
Mailing Address - Street 1:561 MONMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08562-2125
Mailing Address - Country:US
Mailing Address - Phone:609-758-2244
Mailing Address - Fax:609-758-6773
Practice Address - Street 1:561 MONMOUTH RD
Practice Address - Street 2:
Practice Address - City:WRIGHTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08562
Practice Address - Country:US
Practice Address - Phone:609-758-2244
Practice Address - Fax:609-758-6773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI017451122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty