Provider Demographics
NPI:1245100197
Name:NORTH STAR ORAL SURGERY
Entity type:Organization
Organization Name:NORTH STAR ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RAFAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEDELEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-334-0082
Mailing Address - Street 1:250 GIBBSBORO RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-4130
Mailing Address - Country:US
Mailing Address - Phone:856-783-3499
Mailing Address - Fax:856-783-9582
Practice Address - Street 1:250 GIBBSBORO RD STE 2
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-4130
Practice Address - Country:US
Practice Address - Phone:856-783-3499
Practice Address - Fax:856-783-9582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-06
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty