| Gotham Oral & Maxillofacial Surgery P.c. | |
|
563 E Tremont Ave Bronx NY 10457-4655 | |
| (718) 466-4500 | |
| (917) 792-8502 |
| Full Name | Gotham Oral & Maxillofacial Surgery P.c. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 563 E Tremont Ave, Bronx, New York |
| Authorized Official Name and Position | Eleftherios Gavriil (PRESIDENT) |
| Authorized Official Contact | 7184664500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gotham Oral & Maxillofacial Surgery P.c. 563 E Tremont Ave Bronx NY 10457-4655 Ph: (718) 466-4500 | Gotham Oral & Maxillofacial Surgery P.c. 563 E Tremont Ave Bronx NY 10457-4655 Ph: (718) 466-4500 |
| NPI Number | 1710246533 |
|---|---|
| Provider Enumeration Date | 05/14/2012 |
| Last Update Date | 05/14/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710246533 | NPI | - | NPPES |
| 03399171 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 053186 (New York) | Primary |
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