Organization
ADVANCED IMPLANT AND ORAL SURGERY P.C.
Active
Organization
ADVANCED IMPLANT AND ORAL SURGERY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YURIY YUSUPOV DDS (PRESIDENT)
(631) 923-1101
Entity
Organization
Contact information
Practice address
17 WALT WHITMAN RD STE 3, HUNTINGTON STATION, NY 11746-3610
(631) 923-1101
Mailing address
17 WALT WHITMAN RD STE 3, HUNTINGTON STATION, NY 11746-3610
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
052623
NY
Other
Enumeration date
08/26/2011
Last updated
08/26/2011
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