Provider Demographics
NPI:1730503111
Name:PRECISION ORAL SURGERY LLC
Entity type:Organization
Organization Name:PRECISION ORAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINT-CYR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-206-9255
Mailing Address - Street 1:9 E MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3382
Mailing Address - Country:US
Mailing Address - Phone:856-206-9255
Mailing Address - Fax:856-206-9254
Practice Address - Street 1:1765 SPRINGDALE RD
Practice Address - Street 2:SUITE C-1
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2177
Practice Address - Country:US
Practice Address - Phone:856-206-9255
Practice Address - Fax:856-206-9254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI0242661223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty