MEDICARE: TRIBECA ORAL AND MAXILLOFACIAL SURGERY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	051457	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407031867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIBECA ORAL AND MAXILLOFACIAL SURGERY, PLLC

Provider Business Mailing Address
First Line	:	21 MURRAY ST
Second Line	:	2ND FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10007-2239
Country	:	US
Telephone Number	:	212-267-3300
Fax Number	:	212-267-3304

Provider Business Practice Location Address
First Line	:	21 MURRAY ST
Second Line	:	2ND FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10007-2239
Country	:	US
Telephone Number	:	212-267-3300
Fax Number	:	212-267-3304

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. BRETT KING
Credential	:	D.D.S.
Telephone Number	:	212-267-3300

Provider Enumeration Date	:	01/04/2008
Last Update Date	:	01/04/2008

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