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1073060612
STATE STREET SMILES
HACKENSACK, NJ
NPI
1073060612
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Entity Type
Organization
Authorized Contact
EDWARD JACKSON
Doctor
201-487-7030
Organization Subpart ?
Yes
Primary Taxonomy
125K00000X Advanced Practice Dental Therapist
Enumeration Date
2016-09-01
Last Update Date
2016-09-01
Business Address
STATE STREET SMILES
405 MAIN STREET
HACKENSACK, NJ 07601
Phone number: 201-487-7030
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Mailing Address
STATE STREET SMILES
405 MAIN ST
HACKENSACK, NJ 07601-5965
Phone number: 201-487-7030
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