Provider Demographics
NPI:1588729362
Name:VINELAND ORAL SURGEONS PA
Entity type:Organization
Organization Name:VINELAND ORAL SURGEONS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-692-8300
Mailing Address - Street 1:1318 S MAIN RD
Mailing Address - Street 2:BLDG 4 SUITE B
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6516
Mailing Address - Country:US
Mailing Address - Phone:856-692-8300
Mailing Address - Fax:856-692-9229
Practice Address - Street 1:1318 S MAIN RD
Practice Address - Street 2:BLDG 4 SUITE B
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6516
Practice Address - Country:US
Practice Address - Phone:856-692-8300
Practice Address - Fax:856-692-9229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2635607Medicaid
NJ2635607Medicaid
NJU53060Medicare UPIN