Healthcare Provider Details

I. General information

NPI: 1164760328
Provider Name (Legal Business Name): WESTCHESTER ORAL & MAXILLOFACIAL SURGERY & IMPLANTOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 WESTCHESTER AVE
PURCHASE NY
10577-2518
US

IV. Provider business mailing address

2975 WESTCHESTER AVE
PURCHASE NY
10577-2518
US

V. Phone/Fax

Practice location:
  • Phone: 914-281-1283
  • Fax:
Mailing address:
  • Phone: 914-281-1283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number052207
License Number StateNY

VIII. Authorized Official

Name: DR. MIOCHAEL JOHN GRAFFEO
Title or Position: OWNER
Credential: DDS
Phone: 914-281-1283