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General NPI Number Information
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NPI Number | 1609470152
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Entity Type | Organization
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Legal Business Name | NEW ENGLAND ORAL AND FACIAL SURGERY
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Dates
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Enumeration Date | 11/25/2020
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Last Update Date | 11/25/2020
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Provider Practice Location Address
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Address Line | 489 MAIN ST STE C
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City | GROTON
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State | MA
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Zip | 01450-1282
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Country | US
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Telephone | 315-784-6782
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Fax |
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Provider Business Mailing Address
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Address Line | 100 PARK AVE APT 1101
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City | FORT LEE
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State | NJ
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Zip | 07024-3828
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ORAL AND MAXILLOFACIAL SURGEON
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Name | TIFFANY KUANG
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Credential | DMD
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Telephone | 516-304-0250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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