# GREAT LAKES ORAL SURGERY, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174858419
- **Authorized official:** DR. DAVID A. MACGREGOR DMD (OWNER)
- **Authorized official phone:** (315) 343-6160

## Contact information

- **Practice address:** 633 W. 3RD ST. S., FULTON, NY 13069
- **Practice address phone:** (315) 343-6160
- **Practice address fax:** (315) 343-8556
- **Mailing address:** 633 W. 3RD ST. S., FULTON, NY 13069
- **Mailing address phone:** (315) 343-6160
- **Mailing address fax:** (315) 343-8556

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 051594 | NY | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |

## Other

- **Enumeration date:** 10/05/2009
- **Last updated:** 01/31/2019