Provider Demographics
NPI:1710996038
Name:PLAINVIEW ORAL & MAXILLOFACIAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PLAINVIEW ORAL & MAXILLOFACIAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-822-7880
Mailing Address - Street 1:1181 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5018
Mailing Address - Country:US
Mailing Address - Phone:516-822-7880
Mailing Address - Fax:516-822-5010
Practice Address - Street 1:1181 OLD COUNTRY RD
Practice Address - Street 2:SUITE 4
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-5018
Practice Address - Country:US
Practice Address - Phone:516-822-7880
Practice Address - Fax:516-822-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD9W681Medicare ID - Type Unspecified