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General NPI Number Information
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NPI Number | 1851419287
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Entity Type | Organization
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Legal Business Name | ST. LAWRENCE ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES PC
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 04/01/2011
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Provider Practice Location Address
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Address Line | 22 DEPOT STREET MARKET SQUARE MALL SUITE 17
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City | POTSDAM
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State | NY
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Zip | 13676
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Country | US
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Telephone | 315-265-1761
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Fax | 315-265-1768
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Provider Business Mailing Address
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Address Line | 22 DEPOT STREET MARKET SQUARE MALL SUITE 17
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City | POTSDAM
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State | NY
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Zip | 13676-1140
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Country | US
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Telephone | 315-265-1761
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Fax | 315-265-1768
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. ERHARD A. BEUTTENMULLER
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Credential | DDS
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Telephone | 315-265-1761
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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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