Provider Demographics
NPI:1023273695
Name:ATLANTIC SMILES LLC
Entity type:Organization
Organization Name:ATLANTIC SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PUKENAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-645-1900
Mailing Address - Street 1:3069 ENGLISH CREEK AVE
Mailing Address - Street 2:SUITE #304
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-9708
Mailing Address - Country:US
Mailing Address - Phone:609-645-1900
Mailing Address - Fax:
Practice Address - Street 1:3069 ENGLISH CREEK AVE
Practice Address - Street 2:SUITE #304
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-9708
Practice Address - Country:US
Practice Address - Phone:609-645-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 02299000261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental