Individual
ALEX MONTAZEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
285 E MAIN ST STE 108, SMITHTOWN, NY 11787-2912
(631) 265-9700
(631) 265-9703
Mailing address
285 E MAIN ST STE 108, SMITHTOWN, NY 11787-2912
(631) 265-9700
(631) 265-9703
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
042730
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
042730
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0565561
GHI MEDICAL
NY
01
—
116561
CIGNA DMO
—
01
—
1364282
UNITED HEALTHCARE
—
01
—
522421P
HIP
NY
01
—
D99121
EMPIRE BCBS
—
01
—
P3492579
OXFORD
—
Enumeration date
01/16/2007
Last updated
06/23/2021
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