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Great Lakes Oral Surgery, P.c.
Oral and Maxillofacial Surgery (Dentist) in Fulton, New York
NPI 1174858419

Great Lakes Oral Surgery, P.c. is a Oral and Maxillofacial Surgery (Dentist) based in Fulton, NY and is specialized in Oral and Maxillofacial Surgery. Great Lakes Oral Surgery, P.c. practices in Fulton, NY. The NPI Number for Great Lakes Oral Surgery, P.c. is 1174858419 and holds a License No. 051594 (New York).

The current practice location address for Great Lakes Oral Surgery, P.c. is 633 W. 3Rd St. S., Fulton, NY and can be reached out via phone at 315-343-6160 and via fax at 315-343-8556.

Location: 633 W. 3Rd St. S., Fulton, NY, 13069
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1174858419
Provider Name
Great Lakes Oral Surgery, P.c.
Credential
Provider Entity Type
Organization
Address
633 W. 3Rd St. S., Fulton, NY, 13069
Phone Number
315-343-6160
Fax Number
315-343-8556
Provider Enumeration Date
10/05/2009
Last Update Date
03/12/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
03118614 05 NY
institution
Provider Business Practice Location Address Details
Address
633 W. 3Rd St. S.
City
Fulton
State
New York
Zip
13069
Phone Number
315-343-6160
Fax Number
315-343-8556
person
Provider Business Mailing Address Details
Address
633 W. 3Rd St. S.
City
Fulton
State
New York
Zip
13069
Phone Number
315-343-6160
Fax Number
315-343-8556
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Oral and Maxillofacial Surgery
Taxonomy
1223S0112X
License No.
051594 (New York)
Definition
The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
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