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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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