OrganizationActive
201 Oral Surgery
NPI 1073896809 · Oral and Maxillofacial Surgery (Dentist) · Old Tappan, NJ
Provider details
- NPI number
- 1073896809
- Entity type
- Organization
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)Dental Providers
- Authorized official
- Suzanne Waltke, Office Manager
- License
- 22DI01547211 (NJ)
Mailing address
180 Old Tappan Rd
Old Tappan, NJ 07675-7052
Registry dates
- Enumerated
- 2011-09-28
- Last updated
- 2011-09-28
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.