Healthcare Provider Details

I. General information

NPI: 1346433075
Provider Name (Legal Business Name): SUBURBAN ORAL & MAXILLOFACIAL SURGERY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6490 MAIN ST SUITE3
WILLIAMSVILLE NY
14221-5853
US

IV. Provider business mailing address

6490 MAIN ST SUITE3
WILLIAMSVILLE NY
14221-5853
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-2800
  • Fax: 716-631-2814
Mailing address:
  • Phone: 716-631-2800
  • Fax: 716-631-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOSEPH EDWARD MARGARONE III
Title or Position: PRESIDENT
Credential: DDS
Phone: 716-631-2800