Provider Demographics
NPI:1427281351
Name:THE CLIFTON CENTER FOR ORAL SURGERY AND JAW RECONSTRUCTION LLC
Entity type:Organization
Organization Name:THE CLIFTON CENTER FOR ORAL SURGERY AND JAW RECONSTRUCTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-955-0100
Mailing Address - Street 1:905 ALLWOOD RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1945
Mailing Address - Country:US
Mailing Address - Phone:973-955-0100
Mailing Address - Fax:973-955-0264
Practice Address - Street 1:905 ALLWOOD RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1945
Practice Address - Country:US
Practice Address - Phone:973-955-0100
Practice Address - Fax:973-955-0264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18029261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0203262Medicaid