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General NPI Number Information
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NPI Number | 1912948746
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Entity Type | Individual
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Provider Name | LAURENCE DAVID SUSSMAN DDS
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Gender | Male
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 158 MAIN ST
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City | MATAWAN
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State | NJ
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Zip | 07747-4104
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Country | US
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Telephone | 732-566-7648
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Fax | 732-566-1919
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Provider Business Mailing Address
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Address Line | 21 LIBERTY KNLS
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City | COLTS NECK
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State | NJ
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Zip | 07722-1363
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Country | US
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Telephone | 732-741-3377
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Fax | 732-741-4955
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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 | 12856
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License Number State | NJ
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