Provider Demographics
NPI:1265237069
Name:PRISM ORAL SURGERY & IMPLANTS OF SUMMIT
Entity type:Organization
Organization Name:PRISM ORAL SURGERY & IMPLANTS OF SUMMIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-741-2217
Mailing Address - Street 1:55 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2225
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2225
Practice Address - Country:US
Practice Address - Phone:201-741-2217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty