NPIMap

Organization Active NPI

State Street Smiles

  • Advanced Practice Dental Therapist
  • Hackensack, NJ
National Provider Identifier
1073060612
Registry record updated Sep 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice Dental TherapistTaxonomy code 125K00000X
Legal business name
STATE STREET SMILES
Practice address
405 Main Street
Hackensack, NJ 07601
Phone
(201) 487-7030
NPI assigned
Sep 1, 2016
Last updated
Sep 1, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
STATE STREET SMILESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 1, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Edward JacksonNPI 1477640373
Title
Doctor
Phone
(201) 487-7030

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Dental Therapist 125K00000X NU Primary

Addresses

Primary practice location

405 Main Street
Hackensack, NJ 07601

Mailing address

405 Main St
Hackensack, NJ 07601-5965
Phone (201) 487-7030

National Provider Directory

National Provider Directory
Tax ID family
State Street Smiles2 organizations share this tax ID, including this one
Part of
State Street Smiles

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472688000000",
    "number": "1073060612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 MAIN ST",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076015965",
            "telephone_number": "201-487-7030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 MAIN STREET",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "07601",
            "telephone_number": "201-487-7030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE STREET SMILES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE STREET SMILES",
        "enumeration_date": "2016-09-01",
        "last_updated": "2016-09-01",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "201-487-7030",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "125K00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Dental Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.