# SOUTH SHORE ORAL SURGERY ASSOC PC

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

## Provider details

- **NPI number:** 1992889695
- **Authorized official:** MRS. DONNA A VANNESS (OFFICE MANAGER)
- **Authorized official phone:** (516) 766-0580

## Contact information

- **Practice address:** 24 MAPLE AVE, SOUTH SHORE ORAL SURGERY ASSOC PC SUITE 6, ROCKVILLE CENTRE, NY 11570
- **Practice address phone:** (516) 766-0580
- **Practice address fax:** (516) 766-6755
- **Mailing address:** 24 MAPLE AVE, SOUTH SHORE ORAL SURGERY ASSOC PC SUITE 6, ROCKVILLE CENTRE, NY 11570
- **Mailing address phone:** (516) 766-0580
- **Mailing address fax:** (516) 766-6755

## Taxonomy

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

## Other

- **Enumeration date:** 10/25/2006
- **Last updated:** 06/20/2008