| North Shore Oral Surgery, Llc | |
|
285 Middle Country Rd Suite #108 Smithtown NY 11787-2978 | |
| (631) 265-9700 | |
| (631) 265-9703 |
| Full Name | North Shore Oral Surgery, Llc |
|---|---|
| Speciality | Dentist |
| Location | 285 Middle Country Rd, Smithtown, New York |
| Authorized Official Name and Position | Alex Montazem (DOCTOR/OWNER) |
| Authorized Official Contact | 6312659700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Shore Oral Surgery, Llc 285 Middle Country Rd Suite #108 Smithtown NY 11787-2978 Ph: (631) 265-9700 | North Shore Oral Surgery, Llc 285 Middle Country Rd Suite #108 Smithtown NY 11787-2978 Ph: (631) 265-9700 |
| NPI Number | 1619249059 |
|---|---|
| Provider Enumeration Date | 02/01/2012 |
| Last Update Date | 11/30/2016 |
| Medicare PECOS PAC ID | 1759698616 |
|---|---|
| Medicare Enrollment ID | O20150910000588 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619249059 | NPI | - | NPPES |
| 521422P | Other | NY | HIP |
| 0565561 | Other | NY | GHI MEDICAL |
| 1364282 | Other | NY | UNITED HEALTHCARE |
| D99121 | Other | NY | EMPIRE BCBS |
| P3492579 | Other | NY | OXFORD |
| 116561 | Other | NY | CIGNA DMO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 042730 (New York) | Primary |
| Provider Name | Alex Montazem |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1730230574 PECOS PAC ID: 2668789520 Enrollment ID: I20150910000781 |
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