Provider Demographics
NPI:1093195562
Name:BRANCHBURG ORAL, MAXILLOFACIAL AND IMPLANT SURGERY, LLC
Entity type:Organization
Organization Name:BRANCHBURG ORAL, MAXILLOFACIAL AND IMPLANT SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-297-7600
Mailing Address - Street 1:3322 ROUTE 22
Mailing Address - Street 2:SUITE 1207-1208
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3476
Mailing Address - Country:US
Mailing Address - Phone:908-218-0300
Mailing Address - Fax:908-218-0301
Practice Address - Street 1:3322 ROUTE 22
Practice Address - Street 2:SUITE 1207-1208
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3476
Practice Address - Country:US
Practice Address - Phone:908-218-0300
Practice Address - Fax:908-218-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-31
Last Update Date:2015-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023737001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty