# GOTHAM ORAL & MAXILLOFACIAL SURGERY P.C.

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

## Provider details

- **NPI number:** 1710246533
- **Authorized official:** DR. ELEFTHERIOS GAVRIIL DDS (PRESIDENT)
- **Authorized official phone:** (718) 466-4500

## Contact information

- **Practice address:** 563 E TREMONT AVE, BRONX, NY 10457-4655
- **Practice address phone:** (718) 466-4500
- **Practice address fax:** (917) 792-8502
- **Mailing address:** 563 E TREMONT AVE, BRONX, NY 10457-4655
- **Mailing address phone:** (718) 466-4500
- **Mailing address fax:** (917) 792-8502

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 053186 | NY | Yes |

## Other

- **Enumeration date:** 05/14/2012
- **Last updated:** 05/14/2012