| Northern Oral & Maxillofacial Surgery Services. P.c. | |
|
104 Paddock St Suite 103 Watertown NY 13601-3948 | |
| (315) 782-3101 | |
| (315) 782-3223 |
| Full Name | Northern Oral & Maxillofacial Surgery Services. P.c. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Pathology |
| Location | 104 Paddock St, Watertown, New York |
| Authorized Official Name and Position | Lawrence Way (PRESIDENT) |
| Authorized Official Contact | 3157823101 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northern Oral & Maxillofacial Surgery Services. P.c. 104 Paddock St Suite 103 Watertown NY 13601-3948 Ph: () - | Northern Oral & Maxillofacial Surgery Services. P.c. 104 Paddock St Suite 103 Watertown NY 13601-3948 Ph: (315) 782-3101 |
| NPI Number | 1811059892 |
|---|---|
| Provider Enumeration Date | 12/15/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811059892 | NPI | - | NPPES |
| 01137613 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0106X | Dentist - Oral And Maxillofacial Pathology | 0314531 (New York) | Primary |
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