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General NPI Number Information
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NPI Number | 1811088701
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Entity Type | Organization
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Legal Business Name | ORAL AND MAXILLOFACIAL ASSOC OF NUTLEY
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 244 CHESTNUT ST
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City | NUTLEY
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State | NJ
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Zip | 07110-4318
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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 | 244 CHESTNUT STREET
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City | NUTLEY
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State | NJ
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Zip | 07110-4318
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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 | PARTNER
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Name | PHILIP M ECHO
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Credential | DMD
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Telephone | 973-667-5844
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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 | 16959
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License Number State | NJ
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