# SMILIST DENTAL OF NEW JERSEY LLC

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

## Provider details

- **NPI number:** 1376053389
- **Authorized official:** JAY KHORSANDI DDS (MEMBER)
- **Authorized official phone:** (516) 439-4756

## Contact information

- **Practice address:** 305 SOUTH AVE, GARWOOD, NJ 07027-1343
- **Practice address phone:** (516) 439-4756
- **Mailing address:** 40 CUTTERMILL RD STE 400, GREAT NECK, NY 11021-3213

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 22DI02564700 | NJ | — |
| 1223G0001X | General Practice Dentistry | 22DI02564700 | NJ | Yes |

## Other

- **Enumeration date:** 10/04/2017
- **Last updated:** 10/04/2017