Organization
LITTLE SMILES PEDIATRIC DENTISTRY OF SOUTH JERSEY
Active
Other names
Little Smiles
Organization subpart
No
Provider details
NPI number
Authorized official
DARLENE L MANDER (CREDENTIALING/AR)
(856) 207-8406
Entity
Organization
Contact information
Practice address
1206 W SHERMAN AVE STE 4D, VINELAND, NJ 08360-6911
(856) 368-2800
(856) 412-5100
Mailing address
1206 W SHERMAN AVE STE 4D, VINELAND, NJ 08360-6911
(856) 368-2800
(856) 412-5100
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0490644
—
NJ
01
—
06371-03
SPECIALTY PERMIT
NJ
01
—
22DI02457700
DENTAL LICENSE
NJ
Enumeration date
05/01/2024
Last updated
09/17/2024
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