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General NPI Number Information
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NPI Number | 1427281351
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Entity Type | Organization
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Legal Business Name | THE CLIFTON CENTER FOR ORAL SURGERY AND JAW RECONSTRUCTION LLC
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Dates
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Enumeration Date | 08/26/2009
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Last Update Date | 08/26/2009
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Provider Practice Location Address
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Address Line | 905 ALLWOOD RD SUITE 202
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City | CLIFTON
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State | NJ
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Zip | 07012-1945
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Country | US
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Telephone | 973-955-0100
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Fax | 973-955-0264
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Provider Business Mailing Address
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Address Line | 905 ALLWOOD RD SUITE 202
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City | CLIFTON
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State | NJ
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Zip | 07012-1945
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Country | US
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Telephone | 973-955-0100
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Fax | 973-955-0264
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. PAT HERNANDEZ
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Credential |
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Telephone | 973-955-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 18029
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License Number State | NJ
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