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General NPI Number Information
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NPI Number | 1043724222
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Entity Type | Organization
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Legal Business Name | ROBBINSVILLE ORAL AND MAXILLOFACIAL SURGERY LLC
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Dates
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Enumeration Date | 11/27/2017
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Last Update Date | 11/27/2017
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Provider Practice Location Address
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Address Line | 2291 ROUTE 33 STE 1005
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City | HAMILTON
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State | NJ
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Zip | 08690-1717
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Country | US
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Telephone | 901-647-8064
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Fax |
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Provider Business Mailing Address
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Address Line | 308 HIGH ST
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City | MOORESTOWN
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State | NJ
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Zip | 08057-3508
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Country | US
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Telephone | 901-647-8064
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHANDINI HUDSON
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Credential | DDS
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Telephone | 901-647-8064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 22DI02615800
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License Number State | NJ
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