Healthcare Provider Details

I. General information

NPI: 1336298686
Provider Name (Legal Business Name): ORAL & MAXILLOFACIAL ASSOCIATES OF MONTCLAIR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 PLYMOUTH STREET
MONTCLAIR NJ
07042
US

IV. Provider business mailing address

54 PLYMOUTH STREET
MONTCLAIR NJ
07042
US

V. Phone/Fax

Practice location:
  • Phone: 973-746-3466
  • Fax: 973-783-4157
Mailing address:
  • Phone: 973-746-3466
  • Fax: 973-783-4157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI02564900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number22DI01705800WILLIAMG
License Number StateNJ

VIII. Authorized Official

Name: DR. WILLIAM G. RANUCCI
Title or Position: ORAL SURGEON
Credential: DMD
Phone: 973-746-3466