Healthcare Provider Details

I. General information

NPI: 1982852778
Provider Name (Legal Business Name): NORTH JERSEY ORAL SURGEONS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2035 HAMBURG TPKE SUITE J
WAYNE NJ
07470-6251
US

IV. Provider business mailing address

2035 HAMBURG TPKE SUITE J
WAYNE NJ
07470-6251
US

V. Phone/Fax

Practice location:
  • Phone: 973-839-7201
  • Fax: 973-839-5233
Mailing address:
  • Phone: 973-839-7201
  • Fax: 973-839-5233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number11755
License Number StateNJ

VIII. Authorized Official

Name: DR. ALBERT F. KUCHLER JR.
Title or Position: PRESIDENT
Credential: DMD
Phone: 973-839-7201