=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972443042
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SYDELL ORAL SURGERY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2026
-----------------------------------------------------
Last Update Date | 03/30/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 475 OLD MARLTON PIKE
-----------------------------------------------------
City | MARLTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-983-0202
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 SYCAMORE LN
-----------------------------------------------------
City | MOORESTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08057-3859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-304-3610
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORAL SURGEON
-----------------------------------------------------
Name | DR. JEFFREY DAVID LITMAN
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 908-304-3610
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------