Healthcare Provider Details

I. General information

NPI: 1164708665
Provider Name (Legal Business Name): KINGS HIGHWAY ORAL & MAXILLOFACIAL SURGERY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 E 19TH ST
BROOKLYN NY
11229-1302
US

IV. Provider business mailing address

1610 E 19TH ST
BROOKLYN NY
11229-1302
US

V. Phone/Fax

Practice location:
  • Phone: 718-576-6999
  • Fax: 718-576-6996
Mailing address:
  • Phone: 718-576-6999
  • Fax: 718-576-6996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number054408
License Number StateNY

VIII. Authorized Official

Name: DR. SAAR AMRANI
Title or Position: CEO
Credential: DMD, MD
Phone: 718-576-6999