Organization
STATE STREET SMILES PEDIATRIC DENTISTRY LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD M JACKSON DMD,FAAP (PEDIATRIC DENTIST)
(201) 487-7030
Entity
Organization
Contact information
Practice address
405 STATE ST, HACKENSACK, NJ 07601-4421
(201) 487-7030
(201) 487-4418
Mailing address
405 STATE ST, HACKENSACK, NJ 07601-4421
(201) 487-7030
(201) 487-4418
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D121365
NJ
Other
Enumeration date
02/11/2009
Last updated
02/11/2009
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