Organization
FAYETTEVILLE-MANLIUS ORAL SURGERY, P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDIOUS KWAIPA ELLIOT DMD (PRESIDENT)
(315) 692-0449
Entity
Organization
Contact information
Practice address
8240 CAZENOVIA RD STE 60, MANLIUS, NY 13104-8814
(315) 692-0449
(315) 692-6546
Mailing address
8240 CAZENOVIA RD STE 60, MANLIUS, NY 13104-8814
(315) 692-0449
(315) 692-6546
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163-943-4665
—
NJ
Enumeration date
06/16/2021
Last updated
06/16/2021
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