Individual provider · Type 1 NPI

Theodore A. Niebloom, DMD

Oral and Maxillofacial Surgery (Dentist) · West Orange, NJ

NPI number 1689750705 Active

Practice location

101 Old Short Hills Road
West Orange, NJ 07052

Call (973) 736-7616 Map

Fax (973) 325-3487

Specialties and licenses

TaxonomyCodeLicense
Oral and Maxillofacial Surgery (Dentist) Primary 1223S0112X22DI01604200 (NJ)

Oral and Maxillofacial Surgery (Dentist): The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

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About NPI 1689750705

Theodore A. Niebloom, DMD's National Provider Identifier is 1689750705, issued on Oct 31, 2006. The primary taxonomy on file is Oral and Maxillofacial Surgery (Dentist) (1223S0112X), and the practice location is in West Orange, NJ. The record was last updated on Oct 5, 2016.