Provider Demographics
NPI:1891900353
Name:SMILE 1ST DENTAL CARE
Entity Type:Organization
Organization Name:SMILE 1ST DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMONCITO
Authorized Official - Middle Name:C
Authorized Official - Last Name:BENITO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-822-8669
Mailing Address - Street 1:2293 ST. GEORGES AVE.
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065
Mailing Address - Country:US
Mailing Address - Phone:732-822-8669
Mailing Address - Fax:732-381-2997
Practice Address - Street 1:2293 ST. GEORGES AVE.
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065
Practice Address - Country:US
Practice Address - Phone:732-822-8669
Practice Address - Fax:732-381-2997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D102107100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty