Provider Demographics
NPI:1891875019
Name:LAWRENCEVILLE ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:LAWRENCEVILLE ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PERSON
Authorized Official - Last Name:HIPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-896-2999
Mailing Address - Street 1:3100 PRINCETON PIKE
Mailing Address - Street 2:BLDG 4 SUITE F
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2300
Mailing Address - Country:US
Mailing Address - Phone:609-896-2999
Mailing Address - Fax:609-896-0701
Practice Address - Street 1:3100 PRINCETON PIKE
Practice Address - Street 2:BLDG 4 SUITE F
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2300
Practice Address - Country:US
Practice Address - Phone:609-896-2999
Practice Address - Fax:609-896-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD1065451223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJHI070849Medicare ID - Type Unspecified
NJT77661Medicare UPIN