Provider Demographics
NPI:1225293863
Name:ORAL & MAXILLOFACIAL SURGERY OF WESTFIELD
Entity Type:Organization
Organization Name:ORAL & MAXILLOFACIAL SURGERY OF WESTFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:908-232-5551
Mailing Address - Street 1:116 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2184
Mailing Address - Country:US
Mailing Address - Phone:908-232-5551
Mailing Address - Fax:908-232-5557
Practice Address - Street 1:116 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2184
Practice Address - Country:US
Practice Address - Phone:908-232-5551
Practice Address - Fax:908-232-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ21463261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery