Organization
GOTHAM ORAL & MAXILLOFACIAL SURGERY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELEFTHERIOS GAVRIIL DDS (PRESIDENT)
(718) 466-4500
Entity
Organization
Contact information
Practice address
563 E TREMONT AVE, BRONX, NY 10457-4655
(718) 466-4500
(917) 792-8502
Mailing address
563 E TREMONT AVE, BRONX, NY 10457-4655
(718) 466-4500
(917) 792-8502
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
053186
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03399171
—
NY
Enumeration date
05/14/2012
Last updated
05/14/2012
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