Provider Demographics
NPI:1366890642
Name:FORT LEE SMILES
Entity type:Organization
Organization Name:FORT LEE SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:GEDEON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-944-4040
Mailing Address - Street 1:1530 PALISADE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5470
Mailing Address - Country:US
Mailing Address - Phone:201-941-4040
Mailing Address - Fax:201-944-4041
Practice Address - Street 1:1530 PALISADE AVE STE 101
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5470
Practice Address - Country:US
Practice Address - Phone:201-941-4040
Practice Address - Fax:201-944-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty