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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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