| Capital District Oral & Maxillofacial Surgeons | |
|
7 Southwoods Blvd Ste 1 Albany NY 12211-2526 | |
| (518) 445-2505 | |
| Not Available |
| Full Name | Capital District Oral & Maxillofacial Surgeons |
|---|---|
| Speciality | Dentist |
| Location | 7 Southwoods Blvd Ste 1, Albany, New York |
| Authorized Official Name and Position | Leah Ann Maylott (CREDENTIALING ADMINISTRATOR) |
| Authorized Official Contact | 8608748198 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Capital District Oral & Maxillofacial Surgeons 330 Whitney Ave Ste 740 Holyoke MA 01040-2789 Ph: (413) 382-7022 | Capital District Oral & Maxillofacial Surgeons 7 Southwoods Blvd Ste 1 Albany NY 12211-2526 Ph: (518) 445-2505 |
| NPI Number | 1730737545 |
|---|---|
| Provider Enumeration Date | 08/27/2019 |
| Last Update Date | 01/10/2022 |
| Medicare PECOS PAC ID | 2365878220 |
|---|---|
| Medicare Enrollment ID | O20200212002446 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730737545 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Diego E Miron |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1497821854 PECOS PAC ID: 5193829455 Enrollment ID: I20070327000539 |
| Provider Name | Stephen J Demarco |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1578644464 PECOS PAC ID: 9234314766 Enrollment ID: I20110428000023 |
| Provider Name | Kenneth Avrum Wieder |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1346300787 PECOS PAC ID: 8022234160 Enrollment ID: I20140724002470 |
| Provider Name | Timothy Adams |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1508121534 PECOS PAC ID: 6901038413 Enrollment ID: I20170323001727 |
| Provider Name | Luis R Delgado |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1700135076 PECOS PAC ID: 6406119718 Enrollment ID: I20180420000104 |
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