Premier Oral Sugery Group PC

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

DI15472 Issued in NJ

Legal business name

PREMIER ORAL SUGERY GROUP PC

Practice address

617 E Palisade Ave
Englewood Cliffs, NJ 07632-1831

Phone

(201) 567-7500

Fax

(201) 567-7505

NPI assigned

Dec 29, 2009

Last updated

Dec 29, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. John Kallis, DMDNPI 1821086901

Title

Owner

Phone

(201) 567-7500

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John N Kallis, DMD

  • Oral and Maxillofacial Pathology Dentistry
  • Englewood Cliffs, NJ
  • NPI 1821086901
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1262044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262044800000",
    "number": "1033449954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 E PALISADE AVE",
            "city": "ENGLEWOOD CLIFFS",
            "state": "NJ",
            "postal_code": "076321831",
            "telephone_number": "201-567-7500",
            "fax_number": "201-567-7505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 E PALISADE AVE",
            "city": "ENGLEWOOD CLIFFS",
            "state": "NJ",
            "postal_code": "076321831",
            "telephone_number": "201-567-7500",
            "fax_number": "201-567-7505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER ORAL SUGERY GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-29",
        "last_updated": "2009-12-29",
        "status": "A",
        "authorized_official_last_name": "KALLIS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-567-7500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "NJ",
            "license": "DI15472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rita D. Posner, PH.D.
• Igor M Povzhitkov, M.D.
• Precision Radiology LLC
• Premier Acupuncture
• Premier Chiropractic LLC
• Prime Psychiatry LLC
• David M Prince, M.D.
• Prohealth Riverside Dental, PLLC
• PT Medical Center, PC
• Ramy Hany Qilini

• Oral and Maxillofacial Pathology Dentistry in Englewood Cliffs, NJ
• Providers in Englewood Cliffs, NJ by specialty
• Oral and Maxillofacial Pathology Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.