Healthcare Provider Details

I. General information

NPI: 1710996038
Provider Name (Legal Business Name): PLAINVIEW ORAL & MAXILLOFACIAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1181 OLD COUNTRY RD SUITE 4
PLAINVIEW NY
11803-5018
US

IV. Provider business mailing address

1181 OLD COUNTRY RD SUITE 4
PLAINVIEW NY
11803-5018
US

V. Phone/Fax

Practice location:
  • Phone: 516-822-7880
  • Fax: 516-822-5010
Mailing address:
  • Phone: 516-822-7880
  • Fax: 516-822-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BARRY DAVID BASS
Title or Position: VICE PRESIDENT
Credential: D.D.S.
Phone: 516-822-7880