Provider Demographics
NPI:1477622140
Name:GREAT SMILES OF NEW JERSEY LLC
Entity type:Organization
Organization Name:GREAT SMILES OF NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SABATER-WEDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:908-561-0225
Mailing Address - Street 1:10 SHAWNEE DR
Mailing Address - Street 2:SUITE A5
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-5803
Mailing Address - Country:US
Mailing Address - Phone:908-561-0225
Mailing Address - Fax:908-561-0343
Practice Address - Street 1:10 SHAWNEE DR
Practice Address - Street 2:SUITE A5
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-5803
Practice Address - Country:US
Practice Address - Phone:908-561-0225
Practice Address - Fax:908-561-0343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty