Provider Demographics
NPI:1932388923
Name:PERFECT SMILE DENTAL OFFICE PC
Entity Type:Organization
Organization Name:PERFECT SMILE DENTAL OFFICE PC
Other - Org Name:THE PERFECT SMILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-224-9339
Mailing Address - Street 1:326 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2167
Mailing Address - Country:US
Mailing Address - Phone:732-224-9339
Mailing Address - Fax:732-224-1342
Practice Address - Street 1:326 BROAD ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2167
Practice Address - Country:US
Practice Address - Phone:732-224-9339
Practice Address - Fax:732-224-1342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ19585122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty