Provider Demographics
NPI:1831128495
Name:SOMERSET ORAL & MAXILLOFACIAL SURGERY GROUP
Entity type:Organization
Organization Name:SOMERSET ORAL & MAXILLOFACIAL SURGERY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DHARGALKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-725-5585
Mailing Address - Street 1:85 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2114
Mailing Address - Country:US
Mailing Address - Phone:908-725-5585
Mailing Address - Fax:908-725-8203
Practice Address - Street 1:85 W HIGH ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2114
Practice Address - Country:US
Practice Address - Phone:908-725-5585
Practice Address - Fax:908-725-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty