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General NPI Number Information
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NPI Number | 1790271641
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Entity Type | Organization
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Legal Business Name | MORRISTOWN ORAL SURGERY & IMPLANTOLOGY ASSOCIATES LLC
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Dates
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Enumeration Date | 07/03/2018
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Last Update Date | 07/03/2018
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Provider Practice Location Address
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Address Line | 290 MADISON AVE STE 1
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City | MORRISTOWN
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State | NJ
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Zip | 07960-7401
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Country | US
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Telephone | 973-538-5338
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Fax | 973-538-5343
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Provider Business Mailing Address
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Address Line | 2299 STOCKER LN
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City | SCOTCH PLAINS
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State | NJ
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Zip | 07076-2119
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Country | US
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Telephone | 646-643-3195
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Fax | 973-538-5343
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES CHU-WEN FANG
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Credential | DDS
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Telephone | 646-643-3178
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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 | 22D102454800
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License Number State | NJ
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