| Advanced Oral Surgery Of Staten Island | |
|
2025 Richmond Ave Suite Ll2 Staten Island NY 10314-3937 | |
| (718) 284-5500 | |
| (718) 284-5600 |
| Full Name | Advanced Oral Surgery Of Staten Island |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 2025 Richmond Ave, Staten Island, New York |
| Authorized Official Name and Position | Moses D Datson (OWNER/ORAL SURGEON) |
| Authorized Official Contact | 7182845500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Oral Surgery Of Staten Island 2025 Richmond Ave Suite Ll2 Staten Island NY 10314-3937 Ph: (718) 284-5500 | Advanced Oral Surgery Of Staten Island 2025 Richmond Ave Suite Ll2 Staten Island NY 10314-3937 Ph: (718) 284-5500 |
| NPI Number | 1700179124 |
|---|---|
| Provider Enumeration Date | 05/18/2011 |
| Last Update Date | 05/18/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700179124 | NPI | - | NPPES |
| 02282231 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 047288 (New York) | Primary |
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