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General NPI Number Information
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NPI Number | 1265520399
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Entity Type | Organization
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Legal Business Name | MERRICK ORAL SURGERY PLLC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 12/08/2015
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Provider Practice Location Address
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Address Line | 2116 MERRICK AVE SUITE 4008
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City | MERRICK
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State | NY
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Zip | 11566
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Country | US
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Telephone | 516-546-1444
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Fax | 516-546-5576
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Provider Business Mailing Address
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Address Line | 2116 MERRICK AVE SUITE 4008.
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City | MERRICK
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State | NY
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Zip | 11566
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Country | US
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Telephone | 516-546-1444
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Fax | 516-546-5576
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN M DABUNDO
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Credential | DDS
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Telephone | 516-546-1444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State | NY
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