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General NPI Number Information
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NPI Number | 1568755817
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE ORAL SURGERY LLC
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Dates
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Enumeration Date | 05/19/2011
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Last Update Date | 05/19/2011
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Provider Practice Location Address
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Address Line | 168 FRANKLIN TPKE
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City | WALDWICK
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State | NJ
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Zip | 07463-1848
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Country | US
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Telephone | 201-251-9955
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Fax | 201-251-9994
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Provider Business Mailing Address
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Address Line | 168 FRANKLIN TPKE
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City | WALDWICK
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State | NJ
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Zip | 07463-1848
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Country | US
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Telephone | 201-251-9955
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Fax | 201-251-9994
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANDEEP SINGLA
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Credential | DDS,MD
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Telephone | 518-209-0524
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | DI102336300
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License Number State | NJ
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