Provider Demographics
NPI:1265520399
Name:MERRICK ORAL SURGERY PLLC
Entity type:Organization
Organization Name:MERRICK ORAL SURGERY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DABUNDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-546-1444
Mailing Address - Street 1:2116 MERRICK AVE SUITE 4008.
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566
Mailing Address - Country:US
Mailing Address - Phone:516-546-1444
Mailing Address - Fax:516-546-5576
Practice Address - Street 1:2116 MERRICK AVE
Practice Address - Street 2:SUITE 4008
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566
Practice Address - Country:US
Practice Address - Phone:516-546-1444
Practice Address - Fax:516-546-5576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204E00000X, 1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00389937Medicaid
NYD94741Medicare PIN