Provider Demographics
NPI:1144435694
Name:SMILECREATORS, P.A.
Entity type:Organization
Organization Name:SMILECREATORS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVGENI
Authorized Official - Middle Name:
Authorized Official - Last Name:GORIOUNOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-471-8300
Mailing Address - Street 1:139 MAIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07014-1707
Mailing Address - Country:US
Mailing Address - Phone:973-471-8300
Mailing Address - Fax:973-471-6662
Practice Address - Street 1:139 MAIN AVENUE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07014
Practice Address - Country:US
Practice Address - Phone:973-471-8300
Practice Address - Fax:973-471-6662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020941001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty