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General NPI Number Information
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NPI Number | 1518234392
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Entity Type | Organization
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Legal Business Name | COMMACK ORAL AND MAXILLOFACIAL SURGEONS PC
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Dates
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Enumeration Date | 11/22/2011
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 160 COMMACK RD SUITE M1
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City | COMMACK
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State | NY
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Zip | 11725-3412
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Country | US
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Telephone | 631-499-7266
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Fax | 631-499-7525
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Provider Business Mailing Address
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Address Line | 160 COMMACK RD SUITE M1
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City | COMMACK
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State | NY
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Zip | 11725-3412
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Country | US
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Telephone | 631-499-7266
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Fax | 631-499-7525
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID MILLER
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Credential | DDS
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Telephone | 631-499-7266
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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 | 041250
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License Number State | NY
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