Provider Demographics
NPI:1558589895
Name:NORTH SHORE IMPLANT &ORAL SURGERY ASSOCIATES PC
Entity Type:Organization
Organization Name:NORTH SHORE IMPLANT &ORAL SURGERY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-427-7373
Mailing Address - Street 1:790 NEW YORK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4499
Mailing Address - Country:US
Mailing Address - Phone:631-427-7373
Mailing Address - Fax:631-673-6299
Practice Address - Street 1:790 NEW YORK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4499
Practice Address - Country:US
Practice Address - Phone:631-427-7373
Practice Address - Fax:631-673-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty