Provider Demographics
NPI:1922338029
Name:SMILES AHEAD CHILDRENS DENTISTRY, PC
Entity Type:Organization
Organization Name:SMILES AHEAD CHILDRENS DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIERNA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-880-0092
Mailing Address - Street 1:1221 N CHURCH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-1245
Mailing Address - Country:US
Mailing Address - Phone:856-235-0020
Mailing Address - Fax:856-235-0017
Practice Address - Street 1:77 GARLAND LN
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-3011
Practice Address - Country:US
Practice Address - Phone:609-880-0092
Practice Address - Fax:609-880-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021843001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty