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General NPI Number Information
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NPI Number | 1790110021
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Entity Type | Organization
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Legal Business Name | PLATTSBURGH ORAL SURGERY PC
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Dates
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Enumeration Date | 09/05/2013
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 8 AMPERSAND DR
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City | PLATTSBURGH
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State | NY
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Zip | 12901-6500
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Country | US
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Telephone | 518-562-1020
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Fax | 518-562-1022
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Provider Business Mailing Address
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Address Line | 8 AMPERSAND DRIVE
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City | PLATTSBURGH
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State | NY
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Zip | 12901
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Country | US
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Telephone | 518-562-1020
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Fax | 518-562-1022
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Authorized Official
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Title or Position | ORAL SURGEON
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Name | DR. BRADLEY WILLIAM RAY
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Credential | DDS FRCD(C)
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Telephone | 518-562-1020
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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 | 056610
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License Number State | NY
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