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General NPI Number Information
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NPI Number | 1174629521
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTAL & ORAL SURGERY
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 07/24/2007
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Provider Practice Location Address
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Address Line | 401 WINDSOR HIGHWAY
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City | VAILS GATE
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State | NY
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Zip | 12584
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Country | US
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Telephone | 845-569-2000
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Fax | 845-569-4950
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Provider Business Mailing Address
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Address Line | PO BOX 444
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City | VAILS GATE
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State | NY
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Zip | 12584-0444
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Country | US
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Telephone | 845-569-2000
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Fax | 845-569-4950
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Authorized Official
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Title or Position | OWNER
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Name | DR. KAMBIZ ALI ZANGENEH
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Credential | DMD
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Telephone | 845-569-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 042635
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 048694
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 048701
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 052403
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 040518
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 045097
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License Number State | NY
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Taxonomy #7
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 037164
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License Number State | NY
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Taxonomy #8
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 041119
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License Number State | NY
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