# NORTH SHORE ORAL SURGERY, LLC

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

## Provider details

- **NPI number:** 1619249059
- **Authorized official:** ALEX MONTAZEM DMD (DOCTOR/OWNER)
- **Authorized official phone:** (631) 265-9700

## Contact information

- **Practice address:** 285 MIDDLE COUNTRY RD, SUITE \#108, SMITHTOWN, NY 11787-2978
- **Practice address phone:** (631) 265-9700
- **Practice address fax:** (631) 265-9703
- **Mailing address:** 285 MIDDLE COUNTRY RD, SUITE \#108, SMITHTOWN, NY 11787-2978
- **Mailing address phone:** (631) 265-9700
- **Mailing address fax:** (631) 265-9703

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 042730 | NY | Yes |

## Other

- **Enumeration date:** 02/01/2012
- **Last updated:** 11/30/2016