1215565171 NPI number — ADVANCED DENTAL SMILE P.C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215565171 NPI number — ADVANCED DENTAL SMILE P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED DENTAL SMILE P.C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215565171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2224 ROUTE 37 E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOMS RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08753-6000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-608-6478
Provider Business Mailing Address Fax Number:
848-251-2400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2224 ROUTE 37 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08753-6000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-608-6478
Provider Business Practice Location Address Fax Number:
848-251-2400
Provider Enumeration Date:
03/27/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BASAR
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
OSMAN
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
917-847-8538

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)