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General NPI Number Information
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NPI Number | 1528702891
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Entity Type | Organization
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Legal Business Name | RARITAN BAY ORAL SURGERY
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Dates
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Enumeration Date | 04/23/2022
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Last Update Date | 04/23/2022
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Provider Practice Location Address
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Address Line | 453 AMBOY AVE STE 2
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-2949
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Country | US
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Telephone | 732-442-1860
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Fax | 732-874-5198
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Provider Business Mailing Address
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Address Line | 453 AMBOY AVE STE 2
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-2949
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Country | US
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Telephone | 732-442-1860
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Fax | 732-874-5198
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Authorized Official
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Title or Position | ORAL SURGERON/OWNER
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Name | GEORGE FLUGRAD SR.
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Credential | DMD
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Telephone | 732-442-1860
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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 |
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License Number State |
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