Organization
NORTH SHORE ORAL SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEX MONTAZEM DMD (DOCTOR/OWNER)
(631) 265-9700
Entity
Organization
Contact information
Practice address
285 MIDDLE COUNTRY RD, SUITE #108, SMITHTOWN, NY 11787-2978
(631) 265-9700
(631) 265-9703
Mailing address
285 MIDDLE COUNTRY RD, SUITE #108, SMITHTOWN, NY 11787-2978
(631) 265-9700
(631) 265-9703
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
042730
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0565561
GHI MEDICAL
NY
01
—
116561
CIGNA DMO
NY
01
—
1364282
UNITED HEALTHCARE
NY
01
—
521422P
HIP
NY
01
—
D99121
EMPIRE BCBS
NY
01
—
P3492579
OXFORD
NY
Enumeration date
02/01/2012
Last updated
11/30/2016
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