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General NPI Number Information
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NPI Number | 1124115373
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Entity Type | Organization
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Legal Business Name | SCHENECTADY ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 2141 EASTERN PKWY
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City | SCHENECTADY
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State | NY
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Zip | 12309-6347
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Country | US
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Telephone | 518-372-2859
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Fax | 518-370-5983
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Provider Business Mailing Address
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Address Line | 2141 EASTERN PKWY
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City | SCHENECTADY
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State | NY
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Zip | 12309-6347
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Country | US
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Telephone | 518-372-2859
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Fax | 518-370-5983
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. THERESA M DUVAL
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Credential |
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Telephone | 518-372-2859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 044618
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 034224
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License Number State | NY
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