Healthcare Provider Details

I. General information

NPI: 1649249897
Provider Name (Legal Business Name): ORAL & MAXILLOFACIAL SURGERY OF CENTRAL NJ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 WHITEHORSE MERCERVILLE RD
MERCERVILLE NJ
08619-1931
US

IV. Provider business mailing address

2303 WHITEHORSE MERCERVILLE RD
MERCERVILLE NJ
08619-1931
US

V. Phone/Fax

Practice location:
  • Phone: 609-587-2900
  • Fax: 609-587-1749
Mailing address:
  • Phone: 609-587-2900
  • Fax: 609-587-1749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberD10747
License Number StateNJ

VIII. Authorized Official

Name: DR. IRA DANIEL CHEIFETZ
Title or Position: OWNER
Credential: DMD
Phone: 609-587-2900