North Shore Oral Surgery, LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

042730 Issued in NY

Legal business name

NORTH SHORE ORAL SURGERY, LLC

Practice address

285 Middle Country Rd
Suite #108
Smithtown, NY 11787-2978

Phone

(631) 265-9700

Fax

(631) 265-9703

NPI assigned

Feb 1, 2012

Organization subpart

No

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

Authorized official

Name

Alex Montazem, DMD

Title

Doctor/Owner

Phone

(631) 265-9700

Specialties & licenses 1

Addresses

Other identifiers 6

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

{
    "created_epoch": "1328054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480464000000",
    "number": "1619249059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 MIDDLE COUNTRY RD",
            "address_2": "SUITE #108",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872978",
            "telephone_number": "631-265-9700",
            "fax_number": "631-265-9703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 MIDDLE COUNTRY RD",
            "address_2": "SUITE #108",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872978",
            "telephone_number": "631-265-9700",
            "fax_number": "631-265-9703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE ORAL SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-01",
        "last_updated": "2016-11-30",
        "status": "A",
        "authorized_official_last_name": "MONTAZEM",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "631-265-9700",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "042730",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIP",
            "identifier": "521422P",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI  MEDICAL",
            "identifier": "0565561",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1364282",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BCBS",
            "identifier": "D99121",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P3492579",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA DMO",
            "identifier": "116561",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• North Shore Hematology Oncology Associates PC
• North Shore Hematology Oncology Associates PC
• North Shore Medical & Surgical Eye Care PC
• North Shore Medical Accelerator PC
• North Shore Medical Group of the Mount Sinai School of Medicine
• North Shore Orthodontics
• North Shore Psychiatric Consultants PC
• North Shore Psychological Services, PLLC
• North Shore Surgi-Center Inc
• North Shore Surgi-Center Inc.

• Oral and Maxillofacial Surgery (Dentist) in Smithtown, NY
• Providers in Smithtown, 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 Nov 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.