# ST. LAWRENCE ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES PC

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

## Provider details

- **NPI number:** 1851419287
- **Authorized official:** MICHAELA MUNIZ (VP, PAYOR RELATIONS)
- **Authorized official phone:** (469) 324-3242

## Contact information

- **Practice address:** 14 ELM ST STE B, POTSDAM, NY 13676-1945
- **Practice address phone:** (315) 265-1761
- **Practice address fax:** (315) 265-1768
- **Mailing address:** 14 ELM ST STE B, POTSDAM, NY 13676-1945
- **Mailing address phone:** (315) 265-1761
- **Mailing address fax:** (315) 265-1768

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | Yes |

## Other

- **Enumeration date:** 03/26/2007
- **Last updated:** 10/07/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 01456399 | — | NY |