# NORTHERN ORAL & MAXILLOFACIAL SURGERY SERVICES. P.C.

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

## Provider details

- **NPI number:** 1811059892
- **Authorized official:** DR. LAWRENCE WAY D.D.S (PRESIDENT)
- **Authorized official phone:** (315) 782-3101

## Contact information

- **Practice address:** 104 PADDOCK ST, SUITE 103, WATERTOWN, NY 13601-3948
- **Practice address phone:** (315) 782-3101
- **Practice address fax:** (315) 782-3223
- **Mailing address:** 104 PADDOCK ST, SUITE 103, WATERTOWN, NY 13601-3948

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | 0314531 | NY | Yes |

## Other

- **Enumeration date:** 12/15/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 01137613 | — | NY |