Healthcare Provider Details

I. General information

NPI: 1801016845
Provider Name (Legal Business Name): EAST HUDSON ORAL AND MAXILLOFACIAL SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FEDERAL ST SUITE 202
TROY NY
12180-2832
US

IV. Provider business mailing address

500 FEDERAL ST SUITE 202
TROY NY
12180-2832
US

V. Phone/Fax

Practice location:
  • Phone: 518-272-3221
  • Fax: 518-272-2005
Mailing address:
  • Phone: 518-272-3221
  • Fax: 518-272-2005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number044679
License Number StateNY

VIII. Authorized Official

Name: DR. DOUGLAS BRUCE SMAIL
Title or Position: OWNER
Credential: D.D.S.
Phone: 518-272-3221