Provider Demographics
NPI:1982873709
Name:DENVILLE ORAL & MAXILLOFACIAL SURGEONS, LLC
Entity type:Organization
Organization Name:DENVILLE ORAL & MAXILLOFACIAL SURGEONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:973-627-6006
Mailing Address - Street 1:35 W MAIN STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834
Mailing Address - Country:US
Mailing Address - Phone:973-627-6006
Mailing Address - Fax:973-627-4337
Practice Address - Street 1:35 W. MAIN STREET.
Practice Address - Street 2:SUITE 101
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834
Practice Address - Country:US
Practice Address - Phone:973-627-6006
Practice Address - Fax:973-627-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ067896208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH51944Medicare UPIN
NJ052949Medicare PIN