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STATE STREET SMILES
NPI 1073060612
Advanced Practice Dental Therapist in Hackensack, NJ

Active since September 01, 2016
405 MAIN STREET, HACKENSACK, NJ 07601(201) 487-7030 Get Directions Write a Review

NPPES record last updated: September 1, 2016. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About State Street Smiles NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STATE STREET SMILES (NPI 1073060612) is a healthcare organization registered as an advanced practice dental therapist in Hackensack, New Jersey and active in the NPI registry since September 2016. The organization lists Edward Jackson, Doctor, as its authorized official.

NPPES Registry Identity

NPI1073060612
Entity TypeOrganization
Primary Taxonomy125K00000X
Legal Business NameSTATE STREET SMILES
Location Address405 MAIN STREETHackensack, NJ 07601
Mailing Address405 Main StHackensack, NJ 07601-5965 · (201) 487-7030
Phone(201) 487-7030
Organization SubpartYes
Authorized OfficialEdward JacksonDoctor · (201) 487-7030
Enumeration DateSeptember 1, 2016
✔ NPI 1073060612 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAdvanced Practice Dental TherapistDental Providers
Taxonomy Code125K00000X
Definition
An Advanced Practice Dental Therapist is:
(1) A dental therapist who has completed additional training beyond basic dental therapy education and provides dental services in accordance with state advanced practice dental therapist laws or statutes; or
(2) A dental hygienist with a graduate degree in advanced dental therapy prepared for independent and interdependent decision making and direct accountability for clinical judgment across the dental health care continuum.

The individual has been authorized by the relevant state board or a tribal entity to provide services under the remote supervision of a dentist. The functions of the advanced practice dental therapist vary based on the needs of the dentist, the educational preparation of the advanced practice dental therapist and state dental practice acts and regulations.
405 MAIN STREET, Hackensack, NJ 07601
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is State Street Smiles's NPI number?

The NPI number for State Street Smiles is 1073060612. It was assigned to this organization in the NPPES registry on September 1, 2016.

Where is State Street Smiles located?

State Street Smiles is located at 405 Main Street, Hackensack, NJ 07601. The listed phone number is (201) 487-7030.

What is State Street Smiles's specialty?

The primary specialty registered for this NPI is Advanced Practice Dental Therapist with taxonomy code 125K00000X.

When was this NPI record last updated?

The NPPES record for State Street Smiles was last updated on September 1, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.