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Organization
MSC ORAL SURGERY PC
Active
Organization
MSC ORAL SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW CLARK DDS, MD (OWNER)
(920) 312-1833
Entity
Organization
Contact information
Practice address
1468 MADISON AVENUE, ANNENBERG BUILDING 2ND FLOOR, NEW YORK, NY 10029
(920) 312-1833
Mailing address
19 PINE LN, CORTLANDT MANOR, NY 10567-5903
(920) 312-1833
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
06/15/2017
Last updated
06/15/2017
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