Provider Demographics
NPI:1841652781
Name:LOVE YOUR SMILE FAMILY & AESTHETIC DENTISTRY
Entity type:Organization
Organization Name:LOVE YOUR SMILE FAMILY & AESTHETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAISWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-345-9490
Mailing Address - Street 1:196 GROVE AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08086
Mailing Address - Country:US
Mailing Address - Phone:856-345-9490
Mailing Address - Fax:856-579-7863
Practice Address - Street 1:196 GROVE AVE
Practice Address - Street 2:SUITE F
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08086
Practice Address - Country:US
Practice Address - Phone:856-345-9490
Practice Address - Fax:856-579-7863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-21
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D102504700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty