Organization
ADVANCED DENTAL & ORAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAMBIZ ALI ZANGENEH DMD (OWNER)
(845) 569-2000
Entity
Organization
Contact information
Practice address
401 WINDSOR HIGHWAY, VAILS GATE, NY 12584
(845) 569-2000
(845) 569-4950
Mailing address
PO BOX 444, VAILS GATE, NY 12584-0444
(845) 569-2000
(845) 569-4950
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
041119
NY
122300000X
Dentist
042635
NY
122300000X
Dentist
048694
NY
1223E0200X
Endodontics
048701
NY
1223P0300X
Periodontics
052403
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
040518
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
045097
NY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
037164
NY
Other
Enumeration date
09/15/2006
Last updated
07/24/2007
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