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Organization
NORTHERN ORAL & MAXILLOFACIAL SURGERY SERVICES. P.C.
Active
Organization
NORTHERN ORAL & MAXILLOFACIAL SURGERY SERVICES. P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAWRENCE WAY D.D.S (PRESIDENT)
(315) 782-3101
Entity
Organization
Contact information
Practice address
104 PADDOCK ST, SUITE 103, WATERTOWN, NY 13601-3948
(315) 782-3101
(315) 782-3223
Mailing address
104 PADDOCK ST, SUITE 103, WATERTOWN, NY 13601-3948
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
0314531
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01137613
—
NY
Enumeration date
12/15/2006
Last updated
08/22/2020
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