Provider Demographics
NPI:1154783512
Name:EVERSMILE DENTAL, LLC
Entity type:Organization
Organization Name:EVERSMILE DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYZ
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ESTEDRAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-773-3992
Mailing Address - Street 1:479 N MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-5597
Mailing Address - Country:US
Mailing Address - Phone:201-773-3992
Mailing Address - Fax:
Practice Address - Street 1:479 N MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5597
Practice Address - Country:US
Practice Address - Phone:201-773-3992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02622100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty