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General NPI Number Information
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NPI Number | 1346433075
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Entity Type | Organization
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Legal Business Name | SUBURBAN ORAL & MAXILLOFACIAL SURGERY ASSOCIATES PC
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Dates
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Enumeration Date | 08/27/2007
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Last Update Date | 08/27/2007
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Provider Practice Location Address
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Address Line | 6490 MAIN ST SUITE3
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-5853
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Country | US
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Telephone | 716-631-2800
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Fax | 716-631-2814
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Provider Business Mailing Address
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Address Line | 6490 MAIN ST SUITE3
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-5853
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Country | US
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Telephone | 716-631-2800
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Fax | 716-631-2814
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH EDWARD MARGARONE III
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Credential | DDS
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Telephone | 716-631-2800
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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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