Provider Demographics
NPI:1861933194
Name:SUPERSMILES DENTAL, LLC
Entity type:Organization
Organization Name:SUPERSMILES DENTAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAZES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-729-7200
Mailing Address - Street 1:332 SPARTA AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1112
Mailing Address - Country:US
Mailing Address - Phone:973-729-7200
Mailing Address - Fax:
Practice Address - Street 1:332 SPARTA AVE
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1112
Practice Address - Country:US
Practice Address - Phone:973-729-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDIO18449122300000X
NJDIO18446122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty