Provider Demographics
NPI:1699287912
Name:LOVE YOUR SMILE DENTAL CENTER LLC
Entity type:Organization
Organization Name:LOVE YOUR SMILE DENTAL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-801-2486
Mailing Address - Street 1:1529 ROUTE 206
Mailing Address - Street 2:UNIT D
Mailing Address - City:TABERNACLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08088
Mailing Address - Country:US
Mailing Address - Phone:609-801-2486
Mailing Address - Fax:609-801-2565
Practice Address - Street 1:1529 ROUTE 206
Practice Address - Street 2:UNIT D
Practice Address - City:TABERNACLE
Practice Address - State:NJ
Practice Address - Zip Code:08088
Practice Address - Country:US
Practice Address - Phone:609-801-2486
Practice Address - Fax:609-801-2565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02515600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty