Provider Demographics
NPI:1164708665
Name:KINGS HIGHWAY ORAL & MAXILLOFACIAL SURGERY P.C.
Entity Type:Organization
Organization Name:KINGS HIGHWAY ORAL & MAXILLOFACIAL SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AMRANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:718-576-6999
Mailing Address - Street 1:1610 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1302
Mailing Address - Country:US
Mailing Address - Phone:718-576-6999
Mailing Address - Fax:718-576-6996
Practice Address - Street 1:1610 E 19TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1302
Practice Address - Country:US
Practice Address - Phone:718-576-6999
Practice Address - Fax:718-576-6996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0544081223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03172658Medicaid