Healthcare Provider Details

I. General information

NPI: 1730286196
Provider Name (Legal Business Name): MICHAEL DAVID SINGER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 ROUTE 10, SUITE 5 RANDOLPH CENTER FOR ORAL & MAXILLOFACIAL SURGERY
RANDOLPH NJ
07869
US

IV. Provider business mailing address

447 ROUTE 10, SUITE 5 RANDOLPH CENTER FOR ORAL & MAXILLOFACIAL SURGERY
RANDOLPH NJ
07869
US

V. Phone/Fax

Practice location:
  • Phone: 973-328-1555
  • Fax: 973-324-3405
Mailing address:
  • Phone: 973-328-1555
  • Fax: 973-324-3405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI02243000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0479961
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: