| Premier Oral Surgery Of Bergen County Pc | |
|
375 S Washington Ave Bergenfield NJ 07621-4323 | |
| (201) 385-0775 | |
| (201) 385-5375 |
| Full Name | Premier Oral Surgery Of Bergen County Pc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Pathology |
| Location | 375 S Washington Ave, Bergenfield, New Jersey |
| Authorized Official Name and Position | John Kallis (OWNER) |
| Authorized Official Contact | 2013850775 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Oral Surgery Of Bergen County Pc 375 S Washington Ave Bergenfield NJ 07621-4323 Ph: (201) 385-0775 | Premier Oral Surgery Of Bergen County Pc 375 S Washington Ave Bergenfield NJ 07621-4323 Ph: (201) 385-0775 |
| NPI Number | 1316597495 |
|---|---|
| Provider Enumeration Date | 09/19/2019 |
| Last Update Date | 09/19/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316597495 | NPI | - | NPPES |
| DI15472 | Other | NJ | STATE DENTAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0106X | Dentist - Oral And Maxillofacial Pathology | (* (Not Available)) | Primary |
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