Healthcare Provider Details

I. General information

NPI: 1902588171
Provider Name (Legal Business Name): PRECISION ORAL AND MAXILLOFACIAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1992 DEER PARK AVE STE 1
DEER PARK NY
11729-2729
US

IV. Provider business mailing address

1992 DEER PARK AVE STE 1
DEER PARK NY
11729-2729
US

V. Phone/Fax

Practice location:
  • Phone: 631-667-0004
  • Fax: 631-667-3388
Mailing address:
  • Phone: 631-667-0004
  • Fax: 631-667-3388

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. MOHAMED EL-OUNSI
Title or Position: OWNER
Credential: DDS
Phone: 631-667-0004