Provider Demographics
NPI:1760910046
Name:SOUTHERN OCEAN OSIC, INC
Entity Type:Organization
Organization Name:SOUTHERN OCEAN OSIC, INC
Other - Org Name:SOUTHERN OCEAN ORAL SURGERY & IMPLANT CENTER
Other - Org Type:Doing Business As
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 1:1322 ROUTE 72 W STE 204
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2486
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1322 ROUTE 72 W STE 204
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2486
Practice Address - Country:US
Practice Address - Phone:609-978-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI17809204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty