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General NPI Number Information
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NPI Number | 1164378865
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Entity Type | Organization
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Legal Business Name | ML MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 03/06/2026
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | 333 US HIGHWAY 46 STE 2-7D
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City | MOUNTAIN LAKES
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State | NJ
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Zip | 07046-1743
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Country | US
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Telephone | 862-298-5188
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Fax | 862-298-5189
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Provider Business Mailing Address
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Address Line | 333 US HIGHWAY 46 STE 2-7D
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City | MOUNTAIN LAKES
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State | NJ
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Zip | 07046-1743
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Country | US
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Telephone | 862-298-5188
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Fax | 862-298-5189
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Authorized Official
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Title or Position | OWNER/SURGEON
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Name | JONATHAN MICHEL
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Credential | DDS
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Telephone | 862-298-5188
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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 |
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License Number State |
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