| Warren Oral Surgery | |
|
58 Mount Bethel Rd Suite 202 Warren NJ 07059-2654 | |
| (908) 222-7922 | |
| (908) 222-7923 |
| Full Name | Warren Oral Surgery |
|---|---|
| Speciality | Dentist |
| Location | 58 Mount Bethel Rd, Warren, New Jersey |
| Authorized Official Name and Position | Daniel Sullivan (OFFICE MANAGER) |
| Authorized Official Contact | 9082227922 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Warren Oral Surgery 58 Mount Bethel Rd Suite 202 Warren NJ 07059-2654 Ph: (908) 222-7922 | Warren Oral Surgery 58 Mount Bethel Rd Suite 202 Warren NJ 07059-2654 Ph: (908) 222-7922 |
| NPI Number | 1447548607 |
|---|---|
| Provider Enumeration Date | 07/21/2011 |
| Last Update Date | 02/13/2017 |
| Medicare PECOS PAC ID | 7315221264 |
|---|---|
| Medicare Enrollment ID | O20170221002280 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447548607 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 02036700 (New Jersey) | Primary |
| Provider Name | Daniel P Sullivan |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1649376468 PECOS PAC ID: 5395063994 Enrollment ID: I20170221002268 |
| Provider Name | Taneenop Aramphongphan |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1750766358 PECOS PAC ID: 1456641752 Enrollment ID: I20191009003241 |
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