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General NPI Number Information
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NPI Number | 1740088608
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL ORAL SURGERY ALLIANCE OF UPSTATE NEW YORK, PLLC
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Dates
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Enumeration Date | 03/06/2025
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 4708 TRANSIT RD
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City | DEPEW
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State | NY
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Zip | 14043-4862
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Country | US
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Telephone | 716-668-3315
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Fax |
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Provider Business Mailing Address
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Address Line | 125 ENTERPRISE DR STE 100
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City | PITTSBURGH
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State | PA
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Zip | 15275-1223
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Country | US
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Telephone | 724-698-2500
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | KAYLA GRAHAM
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Credential |
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Telephone | 724-698-2474
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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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