Organization
ORAL SURGERY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL J FIDLER DDS (ORAL SURGEON)
(607) 798-7169
Entity
Organization
Contact information
Practice address
161 RIVERSIDE DR, SUITE 201, BINGHAMTON, NY 13905-4176
(607) 798-7169
(607) 798-9204
Mailing address
161 RIVERSIDE DR, SUITE 201, BINGHAMTON, NY 13905-4176
(607) 798-7169
(607) 798-9204
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
030712-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00554912
—
NY
Enumeration date
01/31/2007
Last updated
08/22/2020
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