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Organization
GREAT LAKES ORAL SURGERY, P.C.
Active
Organization
GREAT LAKES ORAL SURGERY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID A. MACGREGOR DMD (OWNER)
(315) 343-6160
Entity
Organization
Contact information
Practice address
633 W. 3RD ST. S., FULTON, NY 13069
(315) 343-6160
(315) 343-8556
Mailing address
633 W. 3RD ST. S., FULTON, NY 13069
(315) 343-6160
(315) 343-8556
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
051594
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
10/05/2009
Last updated
01/31/2019
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