MEDICARE: SERGEI KUZNETSOV ORAL SURGERY SERVICES PC

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)

General Provider Information

NPI Number	:	1972347003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERGEI KUZNETSOV ORAL SURGERY SERVICES PC

Provider Business Mailing Address
First Line	:	441 2ND ST APT 2R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-2520
Country	:	US
Telephone Number	:	480-286-2366
Fax Number	:

Provider Business Practice Location Address
First Line	:	506 3RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-3097
Country	:	US
Telephone Number	:	480-286-2366
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SERGEI KUZNETSOV
Credential	:	DDS, MD
Telephone Number	:	480-286-2366

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	06/24/2024

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