Organization
LONG ISLAND ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES LLP
Active
Organization
LONG ISLAND ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIO JOSEPH CAPUANO DDS (SENIOR PARTNER)
(631) 696-9752
Entity
Organization
Contact information
Practice address
132 TERRYVILLE RD, PORT JEFFERSON STATION, NY 11776-1372
(631) 473-6400
(631) 473-7297
Mailing address
132 TERRYVILLE RD, P.O. BOX 222, PORT JEFFERSON STATION, NY 11776-1372
(631) 473-6400
(631) 473-7297
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A100027760
PTAN
NY
Enumeration date
07/22/2005
Last updated
07/21/2022
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