Provider Demographics
NPI:1629488267
Name:WHITESTONE ORAL & MAXILLOFACIAL SURGERY, LLC
Entity Type:Organization
Organization Name:WHITESTONE ORAL & MAXILLOFACIAL SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:ARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SADEGHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-579-5159
Mailing Address - Street 1:150-43C 14TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357
Mailing Address - Country:US
Mailing Address - Phone:718-747-7899
Mailing Address - Fax:347-436-9569
Practice Address - Street 1:150-43C 14TH AVENUE
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357
Practice Address - Country:US
Practice Address - Phone:718-747-7899
Practice Address - Fax:347-436-9569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0518611223S0112X
NY0532771223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty