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General NPI Number Information
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NPI Number | 1508011305
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Entity Type | Organization
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Legal Business Name | ALL COUNTY ORAL & MAXILLOFACIAL SURGERY LLP
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Dates
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Enumeration Date | 11/20/2008
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Last Update Date | 09/18/2019
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Provider Practice Location Address
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Address Line | 115 BROADHOLLOW RD SUITE 200
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City | MELVILLE
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State | NY
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Zip | 11747-4701
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Country | US
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Telephone | 631-752-1033
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Fax | 631-752-1034
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Provider Business Mailing Address
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Address Line | 115 BROADHOLLOW RD STE 200
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City | MELVILLE
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State | NY
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Zip | 11747-4915
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Country | US
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Telephone | 631-752-1033
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Fax | 631-752-1034
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROSS O CHAVKIN
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Credential | D.D.S.
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Telephone | 631-752-1033
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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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