NPIMap

Organization Active NPI

State Street Smiles Pediatric Dentistry LLC.

  • Pediatric Dentistry
  • Hackensack, NJ
National Provider Identifier
1386883668
Registry record updated Feb 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
D121365 Issued in NJ
Legal business name
STATE STREET SMILES PEDIATRIC DENTISTRY LLC.
Practice address
405 State St
Hackensack, NJ 07601-4421
Phone
(201) 487-7030
Fax
(201) 487-4418
NPI assigned
Feb 11, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2009

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

Authorized official

Name
Dr. Edward M Jackson, DMD,FAAPNPI 1477640373
Title
Pediatric Dentist
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
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X D121365 NJ Primary

Addresses

Primary practice location

405 State St
Hackensack, NJ 07601-4421

Mailing address

405 State St
Hackensack, NJ 07601-4421
Phone (201) 487-7030

National Provider Directory

National Provider Directory
Tax ID family
State Street Smiles Pediatric Dentistry LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

405 State St
Hackensack, NJ 07601
Phone (201) 487-1140

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1234310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234310400000",
    "number": "1386883668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 STATE ST",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076014421",
            "telephone_number": "201-487-7030",
            "fax_number": "201-487-4418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 STATE ST",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076014421",
            "telephone_number": "201-487-7030",
            "fax_number": "201-487-4418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE STREET SMILES PEDIATRIC DENTISTRY LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-11",
        "last_updated": "2009-02-11",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "201-487-7030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD,FAAP"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": "D121365",
            "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 Feb 11, 2009; 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.