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General NPI Number Information
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NPI Number | 1205999380
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Entity Type | Organization
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Legal Business Name | ORAL MAXILLOFACIAL SURGERY OF THE SOUTHERN TIER, PC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 451 W CHURCH ST
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City | ELMIRA
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State | NY
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Zip | 14901-2636
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Country | US
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Telephone | 607-733-3760
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Fax | 607-734-6000
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Provider Business Mailing Address
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Address Line | 451 W CHURCH ST
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City | ELMIRA
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State | NY
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Zip | 14901-2636
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Country | US
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Telephone | 607-733-3760
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Fax | 607-734-6000
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Authorized Official
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Title or Position | SURGEON SECRETARY TREASURER
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Name | DR. MATTHEW B BROWN
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Credential | MD DDS
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Telephone | 607-733-3760
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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 |
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License Number State |
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