Provider Demographics
NPI:1265110969
Name:SICKLERVILLE SMILES
Entity type:Organization
Organization Name:SICKLERVILLE SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MODESTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-709-2802
Mailing Address - Street 1:423 SICKLERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-2555
Mailing Address - Country:US
Mailing Address - Phone:856-728-9200
Mailing Address - Fax:
Practice Address - Street 1:423 SICKLERVILLE RD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-2555
Practice Address - Country:US
Practice Address - Phone:856-728-9200
Practice Address - Fax:856-728-4550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental