Organization
GREAT LAKES ORAL SURGERY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID A. MACGREGOR DMD (OWNER)
(315) 343-6160
Entity
Organization
Contact information
Practice address
633 W. 3RD ST. S., FULTON, NY 13069
(315) 343-6160
(315) 343-8556
Mailing address
633 W. 3RD ST. S., FULTON, NY 13069
(315) 343-6160
(315) 343-8556
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
051594
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03118614
—
NY
Enumeration date
10/05/2009
Last updated
01/31/2019
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