Provider Demographics
NPI:1790271641
Name:MORRISTOWN ORAL SURGERY & IMPLANTOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:MORRISTOWN ORAL SURGERY & IMPLANTOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHU-WEN
Authorized Official - Last Name:FANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-643-3178
Mailing Address - Street 1:2299 STOCKER LN
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-2119
Mailing Address - Country:US
Mailing Address - Phone:646-643-3195
Mailing Address - Fax:973-538-5343
Practice Address - Street 1:290 MADISON AVE STE 1
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7401
Practice Address - Country:US
Practice Address - Phone:973-538-5338
Practice Address - Fax:973-538-5343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1024548001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty