Stony Brook Oral and Facial Surgery PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

051735-1 Issued in NY

Legal business name

STONY BROOK ORAL AND FACIAL SURGERY PC

Practice address

207 Hallock Rd
Suite 2
Stony Brook, NY 11790-3033

Phone

(631) 675-9601

Fax

(631) 675-9602

NPI assigned

Apr 19, 2017

Last updated

Feb 29, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael Proothi, DMD, MDNPI 1124279856

Title

Owner

Phone

(631) 675-9601

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Proothi, DMD, MD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Stony Brook, NY
  • NPI 1124279856
  Medicare reassignment Care Compare group Authorized official
• Nicholas John Montanaro, DDS, MD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Stony Brook, NY
  • NPI 1881150688

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Mitchell Steinberg, DDS, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Scarsdale, NY
  • NPI 1942540281
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1492560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709164800000",
    "number": "1497289037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 HALLOCK RD",
            "address_2": "SUITE 2",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117903033",
            "telephone_number": "631-675-9601",
            "fax_number": "631-675-9602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 HALLOCK RD",
            "address_2": "SUITE 2",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117903033",
            "telephone_number": "631-675-9601",
            "fax_number": "631-675-9602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONY BROOK ORAL AND FACIAL SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-19",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A",
        "authorized_official_last_name": "PROOTHI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-675-9601",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "051735-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Stony Brook, NY
• Providers in Stony Brook, NY by specialty
• Oral and Maxillofacial Surgery (Dentist) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.