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Organization
ST. LAWRENCE ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES PC
Active
Organization
ST. LAWRENCE ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAELA MUNIZ (VP, PAYOR RELATIONS)
(469) 324-3242
Entity
Organization
Contact information
Practice address
14 ELM ST STE B, POTSDAM, NY 13676-1945
(315) 265-1761
(315) 265-1768
Mailing address
14 ELM ST STE B, POTSDAM, NY 13676-1945
(315) 265-1761
(315) 265-1768
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
NULL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01456399
—
NY
Enumeration date
03/26/2007
Last updated
10/07/2026
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