Provider Demographics
NPI:1811319445
Name:ALL SMILES DENTAL GROUP INC
Entity type:Organization
Organization Name:ALL SMILES DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NERMEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIFAI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-740-1416
Mailing Address - Street 1:420 N BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-1439
Mailing Address - Country:US
Mailing Address - Phone:856-740-1416
Mailing Address - Fax:856-740-2513
Practice Address - Street 1:420 N BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-1439
Practice Address - Country:US
Practice Address - Phone:856-740-1416
Practice Address - Fax:856-740-2513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02473000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1223G0001XMedicaid