Provider Demographics
NPI:1407721251
Name:ORAL MAXILLOFACIAL SC LLC
Entity type:Organization
Organization Name:ORAL MAXILLOFACIAL SC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-360-0266
Mailing Address - Street 1:400 TOWNLINE RD STE 140
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2841
Mailing Address - Country:US
Mailing Address - Phone:631-406-9191
Mailing Address - Fax:631-406-9195
Practice Address - Street 1:400 TOWNLINE RD STE 140
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2841
Practice Address - Country:US
Practice Address - Phone:631-406-9191
Practice Address - Fax:631-406-9195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical