Provider Demographics
NPI:1184992646
Name:BRIDGE SMILES DENTAL GROUP PA
Entity type:Organization
Organization Name:BRIDGE SMILES DENTAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEGHADRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:908-782-4418
Mailing Address - Street 1:820 ROUTE 202 NORTH
Mailing Address - Street 2:
Mailing Address - City:NESHANIC STATION
Mailing Address - State:NJ
Mailing Address - Zip Code:08853
Mailing Address - Country:US
Mailing Address - Phone:908-782-4418
Mailing Address - Fax:908-782-8661
Practice Address - Street 1:820 ROUTE 202 NORTH
Practice Address - Street 2:00
Practice Address - City:NESHANIC STATION
Practice Address - State:NJ
Practice Address - Zip Code:08853
Practice Address - Country:US
Practice Address - Phone:908-782-4418
Practice Address - Fax:908-782-8661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 21258122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty