Healthcare Provider Details

I. General information

NPI: 1891959888
Provider Name (Legal Business Name): EXCLUSIVE ORAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 VALLEY ST
SOUTH ORANGE NJ
07079-2824
US

IV. Provider business mailing address

63 VALLEY ST
SOUTH ORANGE NJ
07079-2824
US

V. Phone/Fax

Practice location:
  • Phone: 973-762-5773
  • Fax: 973-762-5003
Mailing address:
  • Phone: 973-762-5773
  • Fax: 973-762-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License NumberD102336300
License Number StateNJ

VIII. Authorized Official

Name: DR. SANDEEP SINGLA
Title or Position: PRESIDENT
Credential: DDS,MD
Phone: 973-762-5773