Organization
ST. LAWRENCE ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERHARD A. BEUTTENMULLER DDS (SECRETARY)
(315) 265-1761
Entity
Organization
Contact information
Practice address
22 DEPOT STREET, MARKET SQUARE MALL SUITE 17, POTSDAM, NY 13676
(315) 265-1761
(315) 265-1768
Mailing address
22 DEPOT STREET, MARKET SQUARE MALL SUITE 17, POTSDAM, NY 13676-1140
(315) 265-1761
(315) 265-1768
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01456399
—
NY
Enumeration date
03/26/2007
Last updated
04/01/2011
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