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General NPI Number Information
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NPI Number | 1447657879
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Entity Type | Organization
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Legal Business Name | CENTER FOR ORAL SURGERY & DENTAL IMPLANTS OF ROSELLE LLC
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Dates
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Enumeration Date | 12/01/2014
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Last Update Date | 12/01/2014
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Provider Practice Location Address
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Address Line | 2305 WOOD AVE
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City | ROSELLE
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State | NJ
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Zip | 07203-2939
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Country | US
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Telephone | 908-241-2114
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Fax |
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Provider Business Mailing Address
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Address Line | 2305 WOOD AVE
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City | ROSELLE
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State | NJ
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Zip | 07203-2939
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Country | US
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Telephone | 908-241-2114
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | AMY LU
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Credential |
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Telephone | 908-241-2114
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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 | 22DI02405816
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 22DI01712700
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License Number State | NJ
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