# AESTHETIC SMILES OF WAYNE PROFESSIONAL ASSOCIATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275798639
- **Authorized official:** HENRY ELLIS III (OWNER OFFICE MANAGER)
- **Authorized official phone:** (973) 696-2444

## Contact information

- **Practice address:** 896 VALLEY ROAD, WAYNE, NJ 07470-2971
- **Practice address phone:** (973) 696-2444
- **Practice address fax:** (973) 696-2888
- **Mailing address:** 896 VALLEY ROAD, WAYNE, NJ 07470-2971
- **Mailing address phone:** (973) 696-2444
- **Mailing address fax:** (973) 696-2888

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 22DI02134100 | NJ | Yes |

## Other

- **Enumeration date:** 07/25/2008
- **Last updated:** 07/25/2008