Provider Demographics
NPI:1831660422
Name:AUTHENTIC SMILES FAMILY DENTAL
Entity Type:Organization
Organization Name:AUTHENTIC SMILES FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:OMAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:267-307-4834
Mailing Address - Street 1:112 MINUTEMAN LN
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-4234
Mailing Address - Country:US
Mailing Address - Phone:267-307-4834
Mailing Address - Fax:
Practice Address - Street 1:777 BLACKWOOD CLEMENTON RD
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021-5966
Practice Address - Country:US
Practice Address - Phone:267-307-4834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-08
Last Update Date:2018-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental