Healthcare Provider Details

I. General information

NPI: 1366654428
Provider Name (Legal Business Name): EAST COAST ORAL AND MAXILLOFACIAL SURGEONS,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S MAIN ST SUITE 201
CAPE MAY COURT HOUSE NJ
08210-2264
US

IV. Provider business mailing address

211 S MAIN ST SUITE 201
CAPE MAY COURT HOUSE NJ
08210-2264
US

V. Phone/Fax

Practice location:
  • Phone: 609-465-9600
  • Fax: 609-465-0336
Mailing address:
  • Phone: 609-465-9600
  • Fax: 609-465-0336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number017511
License Number StateNJ

VIII. Authorized Official

Name: DR. MICHAEL ROBERT TOOHEY
Title or Position: ORAL SURGEON/OWNER
Credential: DMD
Phone: 609-465-9600