STATE STREET SMILES PEDIATRIC DENTISTRY LLC. (NPI# 1386883668) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386883668 |
| Entity Type | Organization |
| Organization Name | STATE STREET SMILES PEDIATRIC DENTISTRY LLC. |
| Practice Address |
405 State St Hackensack NJ 07601-4421 |
| Practice Telephone | 2014877030 |
| Practice Fax Number | 2014874418 |
| Mailing Telephone | 2014877030 |
| Mailing Fax Number | 2014874418 |
| Enumeration Date | 2009-02-11 |
| Last Update Date | 2009-02-11 |
| Authorized Official Name | DR. EDWARD M JACKSON (PEDIATRIC DENTIST) |
| Authorized Official Telephone | 2014877030 |
| Authorized Official Credential | DMD,FAAP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
D121365 | NJ | Dental Providers |
| Street Address |
405 STATE ST |
| City | HACKENSACK |
| State | NJ |
| Zip Code | 07601-4421 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477640373 | Edward Michael Jackson | Dentist | 405 State St, Hackensack, NJ 07601-4421 | 2006-10-10 |
| 1164507042 | Menachem I Stamler | Dentist | 405 State St, Hackensack, NJ 07601-4421 | 2006-10-26 |
| 1295816411 | Dina Stamler Jackson | Dentist | 405 State St, Hackensack, NJ 07601-4421 | 2006-10-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750989414 | Alpha Healthcare Staffing Firm, LLC | Registered Nurse | 194 Passaic Street, Hackensack, NJ 07601 | 2020-10-15 |
| 1396350120 | Lower Limb Institute | Podiatrist | 211 Esses Street, Suite 405, Hackesack, NJ 07601 | 2020-09-09 |
| 1649825233 | Rachel Korenblit | Social Worker | 235 Main St Ste 203, Hackensack, NJ 07601 | 2019-08-09 |
| 1740846567 | Samantha Pirnat | Counselor | 426 Hudson Street, 2nd Floor, Hackensack, NJ 07601 | 2019-05-16 |
| 1881258499 | Tara Lynn Smith | Social Worker | 160 South River Street, Hackensack, NJ 07601 | 2019-04-29 |
| 1922569318 | Solomon Isakov | Dentist | 835 Prospect Ave, Suite 304, Hackensack, NJ 07601 | 2019-03-27 |
| 1114403409 | Mildred Lopez Vasquez | Home Health Aide | 12 Rowland Avenue, Hackensack, NJ 07601 | 2018-07-19 |
| 1538656582 | Zara Pharmacy LLC | Pharmacy | 57 Linden St, Hackensack, NJ 07601 | 2018-04-16 |
| 1447759048 | Maryann Hom | Social Worker | 307 Prospect Avenue, 14e, Hackensack, NJ 07601 | 2018-02-08 |
| 1699274258 | Kirsten Byrnes | Psychologist | Audrey Hepburn Children's House, Hackensack Umc, 12 Second St, Hackensack, NJ 07601 | 2018-02-08 |
| Find all providers in zip 07601 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477640373 | Edward Michael Jackson | Dentist | 405 State St, Hackensack, NJ 07601-4421 | 2006-10-10 |
| 1962992925 | Rising Smiles Pediatric Dentistry Inc | Dentist | 100 Summit Ave, Hackensack, NJ 07601-1263 | 2018-05-15 |
| 1306293469 | Jessica Michelle Listwa | Dentist | 645 Main St, Hackensack, NJ 07601 | 2016-05-18 |
| 1104120153 | Ben Liu | Dentist | 645 Main St, Hackensack, NJ 07601-4712 | 2011-01-05 |
| 1588993893 | Dami Kim | Dentist | 35 Pangborn Pl, Hackensack, NJ 07601-4506 | 2009-12-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508481565 | Kids First Pediatric Dentistry LLC | Dentist | 740 Marne Hwy Ste 103, Moorestown, NJ 08057-3126 | 2020-06-15 |
| 1568008340 | Twinkle Little Star Pediatric Dentistry, LLC | Dentist | 259 Kinderkamack Road, Westwood, NJ 07675 | 2019-11-27 |
| 1558831370 | Amazing Smiles Dentistry for Children, Pa | Dentist | 160 Mountain Ave Ste 101, Hackettstown, NJ 07840-2324 | 2018-12-05 |
| 1063915403 | Singh and Smile Pediatric Dentistry | Dentist | 180 South St Ste 104, New Providence, NJ 07974-1991 | 2018-03-12 |
| 1790285450 | Bright Smiles of Burlington County | Dentist | 693 Main Street, Building B Suite 1, Lumberton, NJ 08048 | 2018-02-19 |
| 1972026144 | Otto M Choi Dds, PC | Dentist | 345 Old Hook Rd, Westwood, NJ 07675-3201 | 2017-07-19 |
| 1386175149 | William Christian Bertram Desonne | Dentist | 1692 Clements Bridge Rd, Deptford, NJ 08096-3028 | 2017-03-23 |
| 1295275758 | Anjali Soni | Dentist | 1910 East Route 70, Ste 9, Cherry Hill, NJ 08003 | 2017-03-03 |
| 1821542176 | Amy R Patel | Dentist | 191 Rte 206 Ste 11, Flanders, NJ 07836-9002 | 2016-08-03 |
| 1891248647 | Lyndhurst Pediatric Dentistry, LLC | Dentist | 710 Ridge Rd, Lyndhurst, NJ 07071-3224 | 2016-07-28 |
| Find all providers with the same taxonomy | ||||
| City | HACKENSACK |
| Zip Code | 07601 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.