Surfside Smile Company LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

SURFSIDE SMILE COMPANY LLC

Practice address

1692 Highway 35
Middletown, NJ 07748

Phone

(757) 214-1091

NPI assigned

Oct 31, 2022

Organization subpart

No

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

Authorized official

Name

Kristianne Macaraeg Kracke, DMDNPI 1386164945

Title

Owner

Phone

(757) 214-1091

Specialties & licenses 1

Addresses

Practitioners 1

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

• Kristianne Vidal Macaraeg Kracke, DMD

  • Pediatric Dentistry
  • Sicklerville, NJ
  • NPI 1386164945
  NPD Authorized official

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

{
    "created_epoch": "1667174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674864000000",
    "number": "1679280630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2404 CHERRY ST",
            "city": "MANASQUAN",
            "state": "NJ",
            "postal_code": "087361523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1692 HIGHWAY 35",
            "city": "MIDDLETOWN",
            "state": "NJ",
            "postal_code": "07748",
            "telephone_number": "757-214-1091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURFSIDE SMILE COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-31",
        "last_updated": "2023-01-28",
        "certification_date": "2023-01-28",
        "status": "A",
        "authorized_official_last_name": "MACARAEG KRACKE",
        "authorized_official_first_name": "KRISTIANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-214-1091",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Middletown, NJ
• Providers in Middletown, 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 28, 2023; 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.