Organization
RIVERSIDE ORAL SURGERY - LIVINGSTON
Active
Other names
Riverside Oral Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
MISS LISA D BROWN (OFFICE MANAGER)
(201) 487-6565
Entity
Organization
Contact information
Practice address
340 E NORTHFIELD RD STE 1C, LIVINGSTON, NJ 07039-4892
(973) 992-4750
Mailing address
130 KINDERKAMACK RD STE 204, RIVER EDGE, NJ 07661-1931
(201) 487-6565
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
22DI02584805
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22DI02584805
STATE DENTAL LICENSE
NJ
Enumeration date
06/26/2018
Last updated
09/26/2022
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