Provider Demographics
NPI:1548931421
Name:SYCAMORE SMILES PEDIATRIC DENTISTRY LLC
Entity type:Organization
Organization Name:SYCAMORE SMILES PEDIATRIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BRITNI
Authorized Official - Middle Name:LOREN
Authorized Official - Last Name:KEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-489-0997
Mailing Address - Street 1:7 OAKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:RUMSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07760-1308
Mailing Address - Country:US
Mailing Address - Phone:908-489-0997
Mailing Address - Fax:
Practice Address - Street 1:1029 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-3186
Practice Address - Country:US
Practice Address - Phone:908-489-0997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA