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General NPI Number Information
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NPI Number | 1396616777
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Entity Type | Organization
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Legal Business Name | 18-00 FLA ORAL SURGERY
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 18-00 FAIR LAWN AVE
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City | FAIR LAWN
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State | NJ
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Zip | 07410-2330
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Country | US
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Telephone | 551-286-3040
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Fax | 551-286-3063
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Provider Business Mailing Address
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Address Line | 18-00 FAIR LAWN AVE
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City | FAIR LAWN
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State | NJ
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Zip | 07410-2330
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Country | US
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Telephone | 551-286-3040
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Fax | 551-286-3063
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Authorized Official
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Title or Position | OWNER
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Name | VINCENT DEBITETTO
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Credential | DMD
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Telephone | 551-286-3040
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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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