Premier Oral Surgery of Bergen County PC

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

Legal business name

PREMIER ORAL SURGERY OF BERGEN COUNTY PC

Practice address

375 S Washington Ave
Bergenfield, NJ 07621-4323

Phone

(201) 385-0775

Fax

(201) 385-5375

NPI assigned

Sep 19, 2019

Last updated

Sep 19, 2019By 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, DMD

Title

Owner

Phone

(201) 385-0775

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1568851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568851200000",
    "number": "1316597495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 S WASHINGTON AVE",
            "city": "BERGENFIELD",
            "state": "NJ",
            "postal_code": "076214323",
            "telephone_number": "201-385-0775",
            "fax_number": "201-385-5375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 S WASHINGTON AVE",
            "city": "BERGENFIELD",
            "state": "NJ",
            "postal_code": "076214323",
            "telephone_number": "201-385-0775",
            "fax_number": "201-385-5375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER ORAL SURGERY OF BERGEN COUNTY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-19",
        "last_updated": "2019-09-19",
        "status": "A",
        "authorized_official_last_name": "KALLIS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-385-0775",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE DENTAL LICENSE",
            "identifier": "DI15472",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "info@posbc.net",
            "affiliation": "N",
            "endpointDescription": "business email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "xrays",
            "address_1": "375 S Washington Ave",
            "city": "Bergenfield",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "076214323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2019; 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.