Individual provider Active NPI

Maxim Sulla, D.D.S.

  • Pediatric Dentistry
  • North Brunswick, NJ
National Provider Identifier
1720007776
Registry record updated Sep 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DI21205 Issued in NJ
Practice address
1330 How LN
North Brunswick, NJ 08902-1702
Phone
(732) 249-1010
Fax
(732) 220-0177
NPI assigned
Jul 19, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X DI21205 NJ Primary

Addresses

Primary practice location

1330 How LN
North Brunswick, NJ 08902-1702

Mailing address

1330 How LN
North Brunswick, NJ 08902-1702
Phone (732) 249-1010

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DI21205NJMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Tender Smiles of Ocean PA Pediatric Dentistry CurrentSince Jun 22, 2021 Accepting new patients
Tender Smiles of Roselle PA Pediatric Dentistry Current Accepting new patients
Tender Smiles of Old Bridge PA Current Accepting new patients
Tender Smiles of Edison PA Pediatric Dentistry Past Accepting new patients
Tender Smiles 4 Kids of Monmouth, LLC Pediatric Dentistry Past Accepting new patients

Locations

105 Berkeley Ave
Ocean, NJ 07712
Phone (732) 774-7007

3333 US Highway 9
Old Bridge, NJ 08857
Phone (732) 679-6666

2209 Wood Ave
Roselle, NJ 07203
Phone (908) 245-5556

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758672000000",
    "number": "1720007776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 HOW LN",
            "city": "NORTH BRUNSWICK",
            "state": "NJ",
            "postal_code": "089021702",
            "telephone_number": "732-249-1010",
            "fax_number": "732-220-0177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 HOW LN",
            "city": "NORTH BRUNSWICK",
            "state": "NJ",
            "postal_code": "089021702",
            "telephone_number": "732-249-1010",
            "fax_number": "732-220-0177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLA",
        "first_name": "MAXIM",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2025-09-24",
        "certification_date": "2025-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": "DI21205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Brunswick, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2025; 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.