Valley Oral & Maxillofacial Surgery, PA

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

DI 18054 Issued in NJ

Legal business name

VALLEY ORAL & MAXILLOFACIAL SURGERY, PA

Doing business as

Valley Oral Surgery

Practice address

370 Union Blvd
Totowa, NJ 07512-2561

Phone

(973) 389-1110

NPI assigned

Jan 31, 2007

Organization subpart

No

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

Authorized official

Name

Vito Modugno, DMD

Title

Owner President

Phone

(201) 681-0440

Specialties & licenses 1

Addresses

Other names 1

• Valley Oral Surgery Doing business as

Locations

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188086400000",
    "number": "1700923216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "370 UNION BLVD",
            "city": "TOTOWA",
            "state": "NJ",
            "postal_code": "075122561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 UNION BLVD",
            "city": "TOTOWA",
            "state": "NJ",
            "postal_code": "075122561",
            "telephone_number": "973-389-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY ORAL & MAXILLOFACIAL SURGERY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-08-26",
        "status": "A",
        "authorized_official_last_name": "MODUGNO",
        "authorized_official_first_name": "VITO",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "201-681-0440",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "NJ",
            "license": "DI 18054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Oral Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Visiting Health Services of New Jersey Inc.
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• Oral and Maxillofacial Pathology Dentistry in Totowa, NJ
• Providers in Totowa, 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 Aug 26, 2007; 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.