Provider Demographics
NPI:1205229895
Name:ROYAL ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:ROYAL ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:IMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMIMI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-625-4048
Mailing Address - Street 1:15 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2711
Mailing Address - Country:US
Mailing Address - Phone:973-625-4048
Mailing Address - Fax:973-625-1984
Practice Address - Street 1:15 2ND AVE
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2711
Practice Address - Country:US
Practice Address - Phone:973-625-4048
Practice Address - Fax:973-625-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI018750041223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty