Provider Demographics
NPI:1225316961
Name:PARAMOUNT ORAL SURGERY AND DENTAL IMPLANT CENTER, LLC
Entity Type:Organization
Organization Name:PARAMOUNT ORAL SURGERY AND DENTAL IMPLANT CENTER, LLC
Other - Org Name:PARAMOUNT ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:908-222-7922
Mailing Address - Street 1:201 EDWARD CURRY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-7105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 EDWARD CURRY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7105
Practice Address - Country:US
Practice Address - Phone:908-222-7922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047368-11223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty