| Fayetteville-manlius Oral Surgery, P.c | |
|
8240 Cazenovia Rd Ste 60 Manlius NY 13104-8814 | |
| (315) 692-0449 | |
| (315) 692-6546 |
| Full Name | Fayetteville-manlius Oral Surgery, P.c |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 8240 Cazenovia Rd Ste 60, Manlius, New York |
| Authorized Official Name and Position | Edious Kwaipa Elliot (PRESIDENT) |
| Authorized Official Contact | 3156920449 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fayetteville-manlius Oral Surgery, P.c 8240 Cazenovia Rd Ste 60 Manlius NY 13104-8814 Ph: (315) 692-0449 | Fayetteville-manlius Oral Surgery, P.c 8240 Cazenovia Rd Ste 60 Manlius NY 13104-8814 Ph: (315) 692-0449 |
| NPI Number | 1649848458 |
|---|---|
| Provider Enumeration Date | 06/16/2021 |
| Last Update Date | 06/16/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649848458 | NPI | - | NPPES |
| 163-943-4665 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
Gary L. Revercomb, Dmd Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 8076 Cazenovia Rd, Manlius, NY 13104 Phone: 315-682-8400 Fax: 315-682-2602 | |
Jason D. Henderson, Dds Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 8179 Cazenovia Rd, Manlius, NY 13104 Phone: 315-685-2246 Fax: 315-682-3914 | |
William H. Karp, D.d.s., Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 8179 Cazenovia Rd, Manlius, NY 13104 Phone: 315-682-2386 Fax: 315-682-3914 |