| Great Lakes Oral Surgery, P.c. | |
|
633 W. 3rd St. S. Fulton NY 13069 | |
| (315) 343-6160 | |
| (315) 343-8556 |
| Full Name | Great Lakes Oral Surgery, P.c. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 633 W. 3rd St. S., Fulton, New York |
| Authorized Official Name and Position | David A. Macgregor (OWNER) |
| Authorized Official Contact | 3153436160 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Oral Surgery, P.c. 633 W. 3rd St. S. Fulton NY 13069 Ph: (315) 343-6160 | Great Lakes Oral Surgery, P.c. 633 W. 3rd St. S. Fulton NY 13069 Ph: (315) 343-6160 |
| NPI Number | 1174858419 |
|---|---|
| Provider Enumeration Date | 10/05/2009 |
| Last Update Date | 01/31/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174858419 | NPI | - | NPPES |
| 03118614 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 051594 (New York) | Primary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Secondary |
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