# SOUTH BEDFORD ORAL & MAXILLOFACIAL SURGERY PLLC

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

## Provider details

- **NPI number:** 1275769929
- **Authorized official:** DR. JASON BAKER DMD (OWNER)
- **Authorized official phone:** (914) 242-1142

## Contact information

- **Practice address:** 105 SOUTH BEDFORD ROAD, SUITE 330, MT. KISCO, NY 10549-3466
- **Practice address phone:** (914) 242-1142
- **Practice address fax:** (914) 242-1147
- **Mailing address:** 105 SOUTH BEDFORD ROAD, SUITE 330, MT. KISCO, NY 10549-3466
- **Mailing address phone:** (914) 242-1142
- **Mailing address fax:** (914) 242-1147

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 049711 | NY | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 051590 | NY | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 052234 | NY | — |

## Other

- **Enumeration date:** 06/09/2009
- **Last updated:** 02/08/2017