Provider Demographics
NPI:1568755817
Name:PROGRESSIVE ORAL SURGERY LLC
Entity Type:Organization
Organization Name:PROGRESSIVE ORAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MD
Authorized Official - Phone:518-209-0524
Mailing Address - Street 1:168 FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1848
Mailing Address - Country:US
Mailing Address - Phone:201-251-9955
Mailing Address - Fax:201-251-9994
Practice Address - Street 1:168 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1848
Practice Address - Country:US
Practice Address - Phone:201-251-9955
Practice Address - Fax:201-251-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI102336300261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery