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General NPI Number Information
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NPI Number | 1922838432
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Entity Type | Organization
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Legal Business Name | GOLD COAST ORAL AND MAXILLOFACIAL SURGERY SYOSSET PLLC
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Dates
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Enumeration Date | 08/07/2024
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 40 UNDERHILL BLVD
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City | SYOSSET
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State | NY
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Zip | 11791-3490
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Country | US
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Telephone | 516-744-6262
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Fax | 516-744-6262
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Provider Business Mailing Address
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Address Line | 55 BRYANT AVE, SUITE 2
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City | ROSLYN
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State | NY
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Zip | 11576
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Country | US
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Telephone | 516-749-3000
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Fax | 516-749-3000
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVE YUSUPOV
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Credential | DDS, MD
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Telephone | 516-749-3000
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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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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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