Provider Demographics
NPI:1346414570
Name:SOUTHERN OCEAN ORAL SURGERY & IMPLANT CENTER, INC.
Entity Type:Organization
Organization Name:SOUTHERN OCEAN ORAL SURGERY & IMPLANT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVILIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-978-1300
Mailing Address - Street 1:1100 ROUTE 72 W
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2468
Mailing Address - Country:US
Mailing Address - Phone:609-978-1300
Mailing Address - Fax:609-978-5550
Practice Address - Street 1:1100 ROUTE 72 W
Practice Address - Street 2:SUITE 202
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2474
Practice Address - Country:US
Practice Address - Phone:609-978-1300
Practice Address - Fax:609-978-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI178091223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U68665Medicare UPIN