| A Beautiful Smile Dentistry, L.l.c. | |
|
1315 Anderson Ave Ste A Fort Lee NJ 07024-1732 | |
| (201) 224-4400 | |
| (201) 224-4418 |
| Full Name | A Beautiful Smile Dentistry, L.l.c. |
|---|---|
| Speciality | Dentist |
| Location | 1315 Anderson Ave, Fort Lee, New Jersey |
| Authorized Official Name and Position | David Jin (OWNER/PROVIDER) |
| Authorized Official Contact | 2012244400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Beautiful Smile Dentistry, L.l.c. 1315 Anderson Ave Ste A Fort Lee NJ 07024-1732 Ph: (201) 224-4400 | A Beautiful Smile Dentistry, L.l.c. 1315 Anderson Ave Ste A Fort Lee NJ 07024-1732 Ph: (201) 224-4400 |
| NPI Number | 1316940224 |
|---|---|
| Provider Enumeration Date | 05/24/2005 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 1557710167 |
|---|---|
| Medicare Enrollment ID | O20231207003321 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316940224 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 22DI02183600 (New Jersey) | Primary |
| 122300000X | Dentist | 047558-1 (New York) | Secondary |
| Provider Name | David Jin |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1255334165 PECOS PAC ID: 7517261399 Enrollment ID: I20231207003282 |
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