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General NPI Number Information
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NPI Number | 1548632896
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Entity Type | Organization
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Legal Business Name | ORAL SURGERY OF NNY PLLC
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Dates
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Enumeration Date | 10/27/2015
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Last Update Date | 12/01/2015
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Provider Practice Location Address
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Address Line | 163 BELLEW AVE S
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City | WATERTOWN
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State | NY
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Zip | 13601-2390
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Country | US
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Telephone | 315-786-3990
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Fax | 315-786-3991
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Provider Business Mailing Address
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Address Line | 163 BELLEW AVE S
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City | WATERTOWN
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State | NY
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Zip | 13601-2390
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Country | US
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Telephone | 315-786-3990
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Fax | 315-786-3991
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Authorized Official
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Title or Position | OWNER
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Name | DR. GERALD J. SCHNEEBERGER
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Credential | DDS
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Telephone | 315-786-3990
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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 |
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