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General NPI Number Information
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NPI Number | 1104267707
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Entity Type | Organization
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Legal Business Name | KNICKERBOCKER ORAL AND FACIAL SURGERY, LLC
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Dates
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Enumeration Date | 07/11/2013
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Last Update Date | 07/11/2013
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Provider Practice Location Address
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Address Line | 300 KNICKERBOCKER RD SUITE 2000
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City | CRESSKILL
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State | NJ
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Zip | 07626-1350
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Country | US
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Telephone | 973-900-1829
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Fax |
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Provider Business Mailing Address
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Address Line | 110 CHRISTIE ST
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City | TENAFLY
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State | NJ
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Zip | 07670-1604
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Country | US
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Telephone |
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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. DORON RINGLER
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Credential | DMD, MD
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Telephone | 973-900-1829
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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 | 22DI02376000
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License Number State | NJ
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