Organization
STATE STREET SMILES
Active
Organization
STATE STREET SMILES
Active
Parent organization
STATE STREET SMILES
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE STREET SMILES
Authorized official
DR. EDWARD JACKSON (DOCTOR)
(201) 487-7030
Entity
Organization
Contact information
Practice address
405 MAIN STREET, HACKENSACK, NJ 07601
(201) 487-7030
Mailing address
405 MAIN ST, HACKENSACK, NJ 07601-5965
(201) 487-7030
Taxonomy
Speciality
Code
Description
License number
State
125K00000X
Advanced Practice Dental Therapist
Primary
—
—
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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