Provider Demographics
NPI:1023835204
Name:GROWING SMILES PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:GROWING SMILES PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NASSI
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGDOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-613-1934
Mailing Address - Street 1:1700 AVENUE OF THE STATES
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 AVENUE OF THE STATES
Practice Address - Street 2:SUITE 106
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701
Practice Address - Country:US
Practice Address - Phone:917-613-1934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental