Provider Demographics
NPI:1780924522
Name:SMILE CENTRAL DENTAL HUDSON COUNTY PC
Entity type:Organization
Organization Name:SMILE CENTRAL DENTAL HUDSON COUNTY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-742-4200
Mailing Address - Street 1:3196 KENNEDY BLVD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-2436
Mailing Address - Country:US
Mailing Address - Phone:973-742-4200
Mailing Address - Fax:973-742-4997
Practice Address - Street 1:3196 KENNEDY BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2436
Practice Address - Country:US
Practice Address - Phone:973-742-4200
Practice Address - Fax:973-742-4997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD21533261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental