# MSC ORAL SURGERY PC

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

## Provider details

- **NPI number:** 1679003255
- **Authorized official:** MATTHEW CLARK DDS, MD (OWNER)
- **Authorized official phone:** (920) 312-1833

## Contact information

- **Practice address:** 1468 MADISON AVENUE, ANNENBERG BUILDING 2ND FLOOR, NEW YORK, NY 10029
- **Practice address phone:** (920) 312-1833
- **Mailing address:** 19 PINE LN, CORTLANDT MANOR, NY 10567-5903
- **Mailing address phone:** (920) 312-1833

## Taxonomy

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

## Other

- **Enumeration date:** 06/15/2017
- **Last updated:** 06/15/2017