Healthcare Provider Details

I. General information

NPI: 1265520399
Provider Name (Legal Business Name): MERRICK ORAL SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 MERRICK AVE SUITE 4008
MERRICK NY
11566
US

IV. Provider business mailing address

2116 MERRICK AVE SUITE 4008.
MERRICK NY
11566
US

V. Phone/Fax

Practice location:
  • Phone: 516-546-1444
  • Fax: 516-546-5576
Mailing address:
  • Phone: 516-546-1444
  • Fax: 516-546-5576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. STEVEN M DABUNDO
Title or Position: OWNER
Credential: DDS
Phone: 516-546-1444