Provider Demographics
NPI:1699731570
Name:ASSOCIATED ORAL & MAXILLOFACIAL ASSOCIATES, P.A.
Entity type:Organization
Organization Name:ASSOCIATED ORAL & MAXILLOFACIAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:TENNENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-589-7900
Mailing Address - Street 1:474 HURFFVILLE CROSSKEYS RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2321
Mailing Address - Country:US
Mailing Address - Phone:856-589-7900
Mailing Address - Fax:856-582-4686
Practice Address - Street 1:474 HURFFVILLE CROSSKEYS RD
Practice Address - Street 2:SUITE C
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2321
Practice Address - Country:US
Practice Address - Phone:856-589-7900
Practice Address - Fax:856-582-4686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2901404Medicaid
NJU22808Medicare UPIN
NJ153312Medicare ID - Type Unspecified