| State Street Smiles Pediatric Dentistry Llc. | |
|
405 State St Hackensack NJ 07601-4421 | |
| (201) 487-7030 | |
| (201) 487-4418 |
| Full Name | State Street Smiles Pediatric Dentistry Llc. |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 405 State St, Hackensack, New Jersey |
| Authorized Official Name and Position | Edward M Jackson (PEDIATRIC DENTIST) |
| Authorized Official Contact | 2014877030 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State Street Smiles Pediatric Dentistry Llc. 405 State St Hackensack NJ 07601-4421 Ph: (201) 487-7030 | State Street Smiles Pediatric Dentistry Llc. 405 State St Hackensack NJ 07601-4421 Ph: (201) 487-7030 |
| NPI Number | 1386883668 |
|---|---|
| Provider Enumeration Date | 02/11/2009 |
| Last Update Date | 02/11/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386883668 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | D121365 (New Jersey) | Primary |
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