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General NPI Number Information
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NPI Number | 1205229895
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Entity Type | Organization
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Legal Business Name | ROYAL ORAL & MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 03/06/2015
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Last Update Date | 03/06/2015
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Provider Practice Location Address
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Address Line | 15 2ND AVE
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City | DENVILLE
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State | NJ
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Zip | 07834-2711
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Country | US
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Telephone | 973-625-4048
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Fax | 973-625-1984
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Provider Business Mailing Address
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Address Line | 15 2ND AVE
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City | DENVILLE
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State | NJ
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Zip | 07834-2711
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Country | US
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Telephone | 973-625-4048
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Fax | 973-625-1984
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Authorized Official
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Title or Position | MANAGER
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Name | DR. IMAD TAMIMI
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Credential | DMD
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Telephone | 973-625-4048
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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 | 22DI01875004
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License Number State | NJ
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