Healthcare Provider Details

I. General information

NPI: 1457468332
Provider Name (Legal Business Name): WEST JERSEY ORAL & MAXILLOFACIAL SURGEONS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 SAND HILL RD SUITE 301
FLEMINGTON NJ
08822-4946
US

IV. Provider business mailing address

6 SAND HILL RD SUITE 301
FLEMINGTON NJ
08822-4946
US

V. Phone/Fax

Practice location:
  • Phone: 908-806-7060
  • Fax: 908-782-1235
Mailing address:
  • Phone: 908-806-7060
  • Fax: 908-782-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number17407
License Number StateNJ

VIII. Authorized Official

Name: MR. JOSEPH J SANSEVERE
Title or Position: D.M.D. ORAL SURGEON
Credential: D.M.D
Phone: 908-806-7060