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General NPI Number Information
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NPI Number | 1063690816
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Entity Type | Organization
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Legal Business Name | GARDEN STATE ORAL SURGERY PA
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Dates
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Enumeration Date | 02/04/2008
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 265 BALDWIN RD
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City | PARSIPPANY
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State | NJ
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Zip | 07054-2007
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Country | US
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Telephone | 973-335-5252
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Fax |
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Provider Business Mailing Address
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Address Line | 265 BALDWIN RD
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City | PARSIPPANY
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State | NJ
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Zip | 07054-2007
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Country | US
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Telephone | 973-335-5252
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN N KALLIS
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Credential | DMD
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Telephone | 973-335-5252
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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 | DI15472
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License Number State | NJ
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