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Organization
SMILIST DENTAL OF NEW JERSEY LLC
Active
Organization
SMILIST DENTAL OF NEW JERSEY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAY KHORSANDI DDS (MEMBER)
(516) 439-4756
Entity
Organization
Contact information
Practice address
305 SOUTH AVE, GARWOOD, NJ 07027-1343
(516) 439-4756
Mailing address
40 CUTTERMILL RD STE 400, GREAT NECK, NY 11021-3213
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
22DI02564700
NJ
1223G0001X
General Practice Dentistry
Primary
22DI02564700
NJ
Other
Enumeration date
10/04/2017
Last updated
10/04/2017
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