Wyckoff Dental Spa LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

WYCKOFF DENTAL SPA LLC

Doing business as

Nuva Smile

Practice address

541 Cedar Hill Ave
Wyckoff, NJ 07481-2150

Phone

(201) 444-2383

NPI assigned

Jan 22, 2024

Organization subpart

No

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

Authorized official

Name

Luis E Martinez

Title

Director of Revenue Cycle

Phone

(732) 801-9176

Specialties & licenses 1

Addresses

Other names 1

• Nuva Smile Doing business as

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

{
    "created_epoch": "1705881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705881600000",
    "number": "1427819895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 CEDAR HILL AVE",
            "city": "WYCKOFF",
            "state": "NJ",
            "postal_code": "074812150",
            "telephone_number": "201-444-2383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "541 CEDAR HILL AVE",
            "city": "WYCKOFF",
            "state": "NJ",
            "postal_code": "074812150",
            "telephone_number": "201-444-2383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYCKOFF DENTAL SPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-22",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "LUIS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "732-801-9176"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nuva Smile",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jill Faber Werner, OTR/L
• Judy White
• Tom R Willemann, PT,OCS,MS
• Tiffani Michelle Winfrey
• Wyckoff Dental Associates, LLC
• Wyckoff Family YMCA
• Wyckoff Ophthalmology, LLC
• Wyckoff Ophthalmology,LLC
• Wyckoff Optical, Inc. (James Tracey Eye Care)
• Wycoff-Nelson (Fyzical Therapy and Balance Centers)

• Dental Clinic/Center in Wyckoff, NJ
• Providers in Wyckoff, NJ by specialty
• Dental Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; 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.