Provider Demographics
NPI:1942315445
Name:TENDER SMILES 4 KIDS OF MONMOUTH, LLC
Entity Type:Organization
Organization Name:TENDER SMILES 4 KIDS OF MONMOUTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAXIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-625-8080
Mailing Address - Street 1:4249 US HIGHWAY 9
Mailing Address - Street 2:BLDG 2 SUITE A
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8308
Mailing Address - Country:US
Mailing Address - Phone:732-625-8080
Mailing Address - Fax:732-625-8003
Practice Address - Street 1:4249 US HIGHWAY 9
Practice Address - Street 2:BLDG 2 SUITE A
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8308
Practice Address - Country:US
Practice Address - Phone:732-625-8080
Practice Address - Fax:732-625-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ212051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty