Provider Demographics
NPI:1366658932
Name:ORAL & MAXILLOFACIAL SURGERY ASSOCIATES PA
Entity Type:Organization
Organization Name:ORAL & MAXILLOFACIAL SURGERY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-751-1808
Mailing Address - Street 1:1910 ROUTE 70 E
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2123
Mailing Address - Country:US
Mailing Address - Phone:856-751-1808
Mailing Address - Fax:856-751-7162
Practice Address - Street 1:1910 ROUTE 70 E
Practice Address - Street 2:SUITE 4
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2123
Practice Address - Country:US
Practice Address - Phone:856-751-1808
Practice Address - Fax:856-751-7162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI009129001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ159652OtherMEDICARE CORP #