Organization
PREMIER ORAL SURGERY OF BERGEN COUNTY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN KALLIS DMD (OWNER)
(201) 385-0775
Entity
Organization
Contact information
Practice address
375 S WASHINGTON AVE, BERGENFIELD, NJ 07621-4323
(201) 385-0775
(201) 385-5375
Mailing address
375 S WASHINGTON AVE, BERGENFIELD, NJ 07621-4323
(201) 385-0775
(201) 385-5375
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DI15472
STATE DENTAL LICENSE
NJ
Enumeration date
09/19/2019
Last updated
09/19/2019
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