# LONG ISLAND ORAL & MAXILLOFACIAL SURGERY, PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LONG ISLAND ORAL & MAXILLOFACIAL SURGERY, PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1710060223
- **Legal business name:** LONG ISLAND ORAL & MAXILLOFACIAL SURGERY, PC
- **Authorized official:** MRS. DEBRA MCQUILLAN (MANAGER)
- **Authorized official phone:** (516) 294-9696

## Contact information

- **Practice address:** 14 VANDERVENTER AVE, STE 260, PORT WASHINGTON, NY 11050-3737
- **Practice address phone:** (516) 944-8330
- **Practice address fax:** (516) 883-1598
- **Mailing address:** 14 VANDERVENTER AVE, STE 260, PORT WASHINGTON, NY 11050-3737
- **Mailing address phone:** (516) 944-8330
- **Mailing address fax:** (516) 883-1598

## Taxonomy

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

## Other

- **Enumeration date:** 10/20/2006
- **Last updated:** 01/11/2008