# GOLD COAST ORAL AND MAXILLOFACIAL SURGERY SYOSSET PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Gold Coast Oral and Maxillofacial Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922838432
- **Authorized official:** DR. STEVE YUSUPOV DDS, MD (OWNER)
- **Authorized official phone:** (516) 749-3000

## Contact information

- **Practice address:** 40 UNDERHILL BLVD, SYOSSET, NY 11791-3490
- **Practice address phone:** (516) 744-6262
- **Practice address fax:** (516) 744-6262
- **Mailing address:** 55 BRYANT AVE, SUITE 2, ROSLYN, NY 11576
- **Mailing address phone:** (516) 749-3000
- **Mailing address fax:** (516) 749-3000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |
| 261QD0000X | Dental Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 08/07/2024
- **Last updated:** 08/07/2024