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Contact Information

STATE STREET SMILES
405 MAIN STREET
HACKENSACK, NJ07601
 Phone: 201-487-7030
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Advanced Practice Dental Therapist

125K00000X
Indicates primary specialty

NPI Profile & details for STATE STREET SMILES · (Female)

NPI # 1073060612
Status Active
Credentials
Entity Individual
Enumeration date 09/01/2016
Last updated 09/01/2016 - About 10 years ago
Sole proprietor 1 Not specified
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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