Provider Demographics
NPI:1407008931
Name:CENTER FOR ORAL & MAXILLOFACIAL SURGERY & DENTAL IMPLANTOLOGY P.C.
Entity Type:Organization
Organization Name:CENTER FOR ORAL & MAXILLOFACIAL SURGERY & DENTAL IMPLANTOLOGY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZLOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-625-2244
Mailing Address - Street 1:15 SCHOOL RD E
Mailing Address - Street 2:SUITE #1
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2062
Mailing Address - Country:US
Mailing Address - Phone:732-625-2244
Mailing Address - Fax:732-625-1244
Practice Address - Street 1:15 SCHOOL RD E
Practice Address - Street 2:SUITE #1
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-2062
Practice Address - Country:US
Practice Address - Phone:732-625-2244
Practice Address - Fax:732-625-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02185300261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery