| Stonegate Oral Surgery, Llp | |
|
2005 Lyell Ave Suite 210 Rochester NY 14606-2323 | |
| (585) 254-5360 | |
| Not Available |
| Full Name | Stonegate Oral Surgery, Llp |
|---|---|
| Speciality | Dentist |
| Location | 2005 Lyell Ave, Rochester, New York |
| Authorized Official Name and Position | Alan S Cassara (PARTNER) |
| Authorized Official Contact | 5852545360 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stonegate Oral Surgery, Llp 2005 Lyell Ave Suite 210 Rochester NY 14606-2323 Ph: (585) 254-5360 | Stonegate Oral Surgery, Llp 2005 Lyell Ave Suite 210 Rochester NY 14606-2323 Ph: (585) 254-5360 |
| NPI Number | 1194987008 |
|---|---|
| Provider Enumeration Date | 07/01/2008 |
| Last Update Date | 05/19/2015 |
| Medicare PECOS PAC ID | 1658496419 |
|---|---|
| Medicare Enrollment ID | O20100916000624 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194987008 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 033748-1 (New York) | Primary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 035902 (New York) | Secondary |
| Provider Name | Alan S Cassara |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1518172063 PECOS PAC ID: 0840316352 Enrollment ID: I20100921001512 |
| Provider Name | Wayne C Jarvis |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1316152879 PECOS PAC ID: 4981896289 Enrollment ID: I20101005000750 |
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