Provider Demographics
NPI:1831807221
Name:SMILE DENTAL SPA PC
Entity type:Organization
Organization Name:SMILE DENTAL SPA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISHANI
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-452-5599
Mailing Address - Street 1:360 OLD BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-2348
Mailing Address - Country:US
Mailing Address - Phone:973-452-5599
Mailing Address - Fax:
Practice Address - Street 1:24 CHAPEL AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-4021
Practice Address - Country:US
Practice Address - Phone:201-521-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty