# ADVANCED BRONX DENTAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Advanced Bronx Oral Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497038608
- **Authorized official:** DR. ALEXANDER MUSHEYEV (DIRECTOR)
- **Authorized official phone:** (718) 292-6209

## Contact information

- **Practice address:** 237 WILLIS AVE, BRONX, NY 10454-2678
- **Practice address phone:** (718) 292-6209
- **Mailing address:** 237 WILLIS AVE, BRONX, NY 10454-2678
- **Mailing address phone:** (718) 292-6209

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0300X | Periodontics | — | NULL | — |
| 1223P0300X | Periodontics | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 09/23/2011
- **Last updated:** 09/23/2011