Healthcare Provider Details

I. General information

NPI: 1336461037
Provider Name (Legal Business Name): MORRIS SUSSEX ORAL SURGERY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HOWARD BLVD SUITE 201
MOUNT ARLINGTON NJ
07856-1532
US

IV. Provider business mailing address

22 HOWARD BLVD SUITE 201
MOUNT ARLINGTON NJ
07856-1532
US

V. Phone/Fax

Practice location:
  • Phone: 973-601-0606
  • Fax: 973-601-1444
Mailing address:
  • Phone: 973-601-0606
  • Fax: 973-601-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDI21734
License Number StateNJ

VIII. Authorized Official

Name: KURT NOTARNICOLA
Title or Position: CO-OWNER
Credential: DDS
Phone: 973-601-0606