Organization
201 ORAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUZANNE WALTKE (OFFICE MANAGER)
(201) 767-4001
Entity
Organization
Contact information
Practice address
180 OLD TAPPAN RD, OLD TAPPAN, NJ 07675-7052
(201) 767-4001
Mailing address
180 OLD TAPPAN RD, OLD TAPPAN, NJ 07675-7052
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
22DI01547211
NJ
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
22DI01805400
NJ
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
22DI02332400
NJ
Other
Enumeration date
09/28/2011
Last updated
09/28/2011
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