Provider Demographics
NPI:1972737583
Name:SMILE CENTRAL PASSAIC P.C.
Entity type:Organization
Organization Name:SMILE CENTRAL PASSAIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-658-8839
Mailing Address - Street 1:625 MAIN AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4952
Mailing Address - Country:US
Mailing Address - Phone:973-574-1000
Mailing Address - Fax:973-574-1001
Practice Address - Street 1:625 MAIN AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4952
Practice Address - Country:US
Practice Address - Phone:973-574-1000
Practice Address - Fax:973-574-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021533001223G0001X
NJ22DI022830001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty