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General NPI Number Information
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NPI Number | 1730396029
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Entity Type | Individual
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Provider Name | PHILIP M ECHO DMD
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 187 WASHINGTON AVENUE, SUITE 1 B THE CENTER FOR ORAL & MAXILLOFACIAL SURGERY & IMPLANTOL
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City | NUTLEY
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State | NJ
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Zip | 07110-1995
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Country | US
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Telephone | 973-667-5844
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Fax | 973-667-6653
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Provider Business Mailing Address
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Address Line | 187 WASHINGTON AVENUE, SUITE 1 B THE CENTER FOR ORAL & MAXILLOFACIAL SURGERY & IMPLANTOL
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City | NUTLEY
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State | NJ
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Zip | 07110-1995
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Country | US
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Telephone | 973-667-5844
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Fax | 973-667-6653
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | D1016959
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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 | 22DI01695900
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License Number State | NJ
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