201 Oral Surgery
Dentist, Oral and Maxillofacial Surgery in Old Tappan, NJ. Organization (NPI-2).
NPI number1073896809
StatusActive
Last updated in NPPESSep 28, 2011
Details
- NPI
- 1073896809
- Entity type
- Organization (NPI-2)
- Legal business name
- 201 Oral Surgery
- Organization subpart
- No
- Enumeration date
- Sep 28, 2011
- Last updated
- Sep 28, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | 22DI02332400 | NJ | Yes |
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | 22DI01547211 | NJ | |
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | 22DI01805400 | NJ |
Practice location
180 Old Tappan RdOld Tappan, NJ 07675-7052
Phone 201-767-4001
Mailing address
180 Old Tappan RdOld Tappan, NJ 07675-7052
Authorized official
Suzanne Waltke
Office Manager
2017674001
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