Provider Demographics
NPI:1972989184
Name:ISMILE DENTAL ARTS, PC
Entity Type:Organization
Organization Name:ISMILE DENTAL ARTS, PC
Other - Org Name:ISMILE DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:KASSEM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-287-1158
Mailing Address - Street 1:43 MULLEN DR
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1300
Mailing Address - Country:US
Mailing Address - Phone:856-287-1158
Mailing Address - Fax:
Practice Address - Street 1:368 BERLIN CROSS KEYS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094
Practice Address - Country:US
Practice Address - Phone:856-287-1158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02376800261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental