Provider Demographics
NPI:1811143043
Name:ATLANTIC ORAL & MAXILLOFACIAL ASSOCIATES P.A.
Entity type:Organization
Organization Name:ATLANTIC ORAL & MAXILLOFACIAL ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:S
Authorized Official - Last Name:JUNGELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-677-1001
Mailing Address - Street 1:1124 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-2540
Mailing Address - Country:US
Mailing Address - Phone:609-677-1001
Mailing Address - Fax:
Practice Address - Street 1:1124 SHORE RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-2540
Practice Address - Country:US
Practice Address - Phone:609-677-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D102243200204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty