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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