# SOUTH JERSEY ORAL & MAXILLOFACIAL SURGEONS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447272562
- **Authorized official:** DR. AMERIGO FEDELI DMD (DOCTOR)
- **Authorized official phone:** (609) 654-1300

## Contact information

- **Practice address:** 135 JACKSON RD, SUITE A, MEDFORD, NJ 08055-9231
- **Practice address phone:** (609) 654-1300
- **Practice address fax:** (609) 654-0040
- **Mailing address:** 135 JACKSON RD, SUITE A, MEDFORD, NJ 08055-9231
- **Mailing address phone:** (609) 654-1300
- **Mailing address fax:** (609) 654-0040

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |
| 1223X0008X | Oral and Maxillofacial Radiology Dentistry | — | NULL | — |
| 1223X0008X | Oral and Maxillofacial Radiology Dentistry | — | — | — |

## Other

- **Enumeration date:** 07/25/2006
- **Last updated:** 06/30/2008