MEDICARE: EXCLUSIVE ORAL SURGERY

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	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center	D102336300	NJ

General Provider Information

NPI Number	:	1891959888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCLUSIVE ORAL SURGERY

Provider Business Mailing Address
First Line	:	63 VALLEY ST
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-2824
Country	:	US
Telephone Number	:	973-762-5773
Fax Number	:	973-762-5003

Provider Business Practice Location Address
First Line	:	63 VALLEY ST
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-2824
Country	:	US
Telephone Number	:	973-762-5773
Fax Number	:	973-762-5003

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SANDEEP SINGLA
Credential	:	DDS,MD
Telephone Number	:	973-762-5773

Provider Enumeration Date	:	07/18/2008
Last Update Date	:	04/09/2015

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