Provider Demographics
NPI:1932304615
Name:PRINCETON ORAL AND MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:PRINCETON ORAL AND MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-924-1621
Mailing Address - Street 1:166 BUNN DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2800
Mailing Address - Country:US
Mailing Address - Phone:609-924-1621
Mailing Address - Fax:609-924-6291
Practice Address - Street 1:166 BUNN DR
Practice Address - Street 2:SUITE 103
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2800
Practice Address - Country:US
Practice Address - Phone:609-924-1621
Practice Address - Fax:609-924-6291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ595270Medicare ID - Type Unspecified