Provider Demographics
NPI:1336461037
Name:MORRIS SUSSEX ORAL SURGERY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MORRIS SUSSEX ORAL SURGERY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:NOTARNICOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-601-0606
Mailing Address - Street 1:22 HOWARD BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MOUNT ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07856-1532
Mailing Address - Country:US
Mailing Address - Phone:973-601-0606
Mailing Address - Fax:973-601-1444
Practice Address - Street 1:22 HOWARD BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:MOUNT ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07856-1532
Practice Address - Country:US
Practice Address - Phone:973-601-0606
Practice Address - Fax:973-601-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI217341223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty