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General NPI Number Information
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NPI Number | 1811143043
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Entity Type | Organization
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Legal Business Name | ATLANTIC ORAL & MAXILLOFACIAL ASSOCIATES P.A.
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Dates
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Enumeration Date | 08/07/2008
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 1124 SHORE RD
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City | NORTHFIELD
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State | NJ
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Zip | 08225-2540
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Country | US
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Telephone | 609-677-1001
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Fax |
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Provider Business Mailing Address
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Address Line | 1124 SHORE RD
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City | NORTHFIELD
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State | NJ
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Zip | 08225-2540
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Country | US
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Telephone | 609-677-1001
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Fax |
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Authorized Official
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Title or Position | D.M.D.
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Name | DR. BRADFORD S. JUNGELS
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Credential |
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Telephone | 609-677-1001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 22D102243200
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License Number State | NJ
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