Provider Demographics
NPI:1871964908
Name:THE SMILE STATION LLC
Entity type:Organization
Organization Name:THE SMILE STATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LORINO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-751-4040
Mailing Address - Street 1:286 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2082
Mailing Address - Country:US
Mailing Address - Phone:973-751-4040
Mailing Address - Fax:973-751-4060
Practice Address - Street 1:286 UNION AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-2082
Practice Address - Country:US
Practice Address - Phone:973-751-4040
Practice Address - Fax:973-751-4060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021526001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty