Provider Demographics
NPI:1619315124
Name:ADVANCED ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:ADVANCED ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEFALCO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-262-2667
Mailing Address - Street 1:270 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5343
Mailing Address - Country:US
Mailing Address - Phone:201-262-2667
Mailing Address - Fax:201-262-2608
Practice Address - Street 1:270 SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5343
Practice Address - Country:US
Practice Address - Phone:201-262-2667
Practice Address - Fax:201-262-2608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01861300305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization