Healthcare Provider Details

I. General information

NPI: 1679704431
Provider Name (Legal Business Name): ALBANY ORAL - MAXILLOFACIAL SURGERY GROUP, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 EXECUTIVE PARK DR
ALBANY NY
12203-3700
US

IV. Provider business mailing address

2 EXECUTIVE PARK DR
ALBANY NY
12203-3700
US

V. Phone/Fax

Practice location:
  • Phone: 518-446-1001
  • Fax: 518-446-0802
Mailing address:
  • Phone: 518-446-1001
  • Fax: 518-446-0802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. LAWRENCE JAMES BUSINO
Title or Position: CO MEDICAL DIRECTOR
Credential: DDS
Phone: 518-446-1001