Provider Demographics
NPI:1013450717
Name:NJ SMILES OF WOODBRIDGE
Entity Type:Organization
Organization Name:NJ SMILES OF WOODBRIDGE
Other - Org Name:NJ SMILES DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARDEEK
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:908-756-5800
Mailing Address - Street 1:1170 ST.GEORGES AVE
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001
Mailing Address - Country:US
Mailing Address - Phone:732-218-6070
Mailing Address - Fax:
Practice Address - Street 1:1170 ST.GEORGES AVE
Practice Address - Street 2:
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001
Practice Address - Country:US
Practice Address - Phone:732-218-6070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ022DI022917001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty