Healthcare Provider Details

I. General information

NPI: 1124272737
Provider Name (Legal Business Name): WESTCHESTER ORAL & MAXILLOFACIAL ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE STE 2500 N
HAWTHORNE NY
10532-2140
US

IV. Provider business mailing address

19 BRADHURST AVE 2500 N
HAWTHORNE NY
10532
US

V. Phone/Fax

Practice location:
  • Phone: 914-592-0440
  • Fax: 914-592-0455
Mailing address:
  • Phone: 914-592-0440
  • Fax: 914-592-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number050522
License Number StateNY

VIII. Authorized Official

Name: DR. BENJAMIN KUR
Title or Position: ORAL SURGEON
Credential: DDS
Phone: 914-592-0440