Provider Demographics
NPI:1720838493
Name:MARVEL SMILES CORNWALL DENTAL PLLC
Entity Type:Organization
Organization Name:MARVEL SMILES CORNWALL DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANURAG
Authorized Official - Middle Name:
Authorized Official - Last Name:HARSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-220-3333
Mailing Address - Street 1:388A UNDERCLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-7251
Mailing Address - Country:US
Mailing Address - Phone:212-220-3333
Mailing Address - Fax:
Practice Address - Street 1:222 MAIN ST
Practice Address - Street 2:
Practice Address - City:CORNWALL
Practice Address - State:NY
Practice Address - Zip Code:12518-1514
Practice Address - Country:US
Practice Address - Phone:845-534-3828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty