201 ORAL SURGERY NPI 1073896809

NPI Information

  • NPI: 1073896809
  • Provider Name: 201 ORAL SURGERY
  • Classification: Dentist - 1223S0112X
  • Specialization: Oral and Maxillofacial Surgery
  • Entity Type: Organization
  • Address: 180 OLD TAPPAN RD
    OLD TAPPAN, NJ
    ZIP 07675
  • Phone: (201) 767-4001

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NPI Details

201 ORAL SURGERY is an oral and maxillofacial surgery dentist in Old Tappan, NJ. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. 201 ORAL SURGERY NPI is 1073896809. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

180 OLD TAPPAN RD
OLD TAPPAN, NJ
ZIP 07675-052
Phone: (201) 767-4001

The provider's authorized official is Suzanne Waltke .
The authorized official title is Office Manager and has the following contact phone number (201) 767-4001.

The enumeration date for this NPI number is 9/28/2011 and was last updated on 9/28/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223S0112XDentistOral and Maxillofacial Surgery22DI01547211NEW JERSEYNo
21223S0112XDentistOral and Maxillofacial Surgery22DI01805400NEW JERSEYNo
31223S0112XDentistOral and Maxillofacial Surgery22DI02332400NEW JERSEYYes

What is NPI?

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This page was last updated on: 11/21/2025

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