Healthcare Provider Details

I. General information

NPI: 1013167873
Provider Name (Legal Business Name): ORALFACIAL ESTHETICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 E ALLENDALE RD SUITE 1B
SADDLE RIVER NJ
07458-3057
US

IV. Provider business mailing address

82 E ALLENDALE RD SUITE 1B
SADDLE RIVER NJ
07458-3057
US

V. Phone/Fax

Practice location:
  • Phone: 201-760-0994
  • Fax: 201-760-0996
Mailing address:
  • Phone: 201-760-0994
  • Fax: 201-760-0996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN JACKSON
Title or Position: PRESIDENT
Credential: DMD
Phone: 201-760-0994