MEDICARE: AFFILIATED ORAL SURGERY GROUP,PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	15562	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D15562	OTHER	NJ	DENTAL LICENSE

General Provider Information

NPI Number	:	1265578850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFILIATED ORAL SURGERY GROUP,PC

Provider Business Mailing Address
First Line	:	1113 HOSPITAL DR
Second Line	:	SUITE 300
City	:	WILLINGBORO
State	:	NJ
Zip	:	08046-1103
Country	:	US
Telephone Number	:	609-877-2030
Fax Number	:	609-877-6872

Provider Business Practice Location Address
First Line	:	1113 HOSPITAL DR
Second Line	:	SUITE 300
City	:	WILLINGBORO
State	:	NJ
Zip	:	08046-1103
Country	:	US
Telephone Number	:	609-877-2030
Fax Number	:	609-877-6872

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSEPH P. FOCARILE
Credential	:	D.M.D.
Telephone Number	:	609-877-2030

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	08/22/2020

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