Provider Demographics
NPI:1831532878
Name:FREEHOLD SMILES FAMILY DENTISTRY P.A.
Entity type:Organization
Organization Name:FREEHOLD SMILES FAMILY DENTISTRY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-625-9600
Mailing Address - Street 1:122 PROFESSIONAL VIEW DR
Mailing Address - Street 2:BUILDING 100
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-7902
Mailing Address - Country:US
Mailing Address - Phone:732-625-9600
Mailing Address - Fax:732-625-9800
Practice Address - Street 1:122 PROFESSIONAL VIEW DR
Practice Address - Street 2:BUILDING 100
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-7902
Practice Address - Country:US
Practice Address - Phone:732-625-9600
Practice Address - Fax:732-625-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024078011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty