Healthcare Provider Details

I. General information

NPI: 1891616207
Provider Name (Legal Business Name): SCUTARI CARDOSO & CUNNINGHAM ORAL & MAXILLOFACIAL SURGERY LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 MEDICAL CENTER DRIVE SUITE B13
FAYETTEVILLE NY
13066
US

IV. Provider business mailing address

4000 MEDICAL CENTER DRIVE SUITE B13
FAYETTEVILLE NY
13066
US

V. Phone/Fax

Practice location:
  • Phone: 315-671-4289
  • Fax:
Mailing address:
  • Phone: 315-671-4289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: DR. PASQUALE SCUTARI JR.
Title or Position: OWNER/ORAL SURGEON
Credential: DDS
Phone: 315-263-4630