Provider Demographics
NPI:1962992925
Name:RISING SMILES PEDIATRIC DENTISTRY INC
Entity type:Organization
Organization Name:RISING SMILES PEDIATRIC DENTISTRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADELFI
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-543-1790
Mailing Address - Street 1:176 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1310
Mailing Address - Country:US
Mailing Address - Phone:201-525-0202
Mailing Address - Fax:201-525-1075
Practice Address - Street 1:100 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1263
Practice Address - Country:US
Practice Address - Phone:201-820-0100
Practice Address - Fax:201-820-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI019937001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty