GREAT LAKES ORAL SURGERY, P.C.
NPI 1174858419
Dentist - Oral and Maxillofacial Surgery in Fulton, NY

Active since October 05, 2009
633 W. 3RD ST. S., FULTON, NY 13069(315) 343-6160(315) 343-8556 Get Directions Write a Review

NPPES record last updated: January 31, 2019. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Great Lakes Oral Surgery, P.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GREAT LAKES ORAL SURGERY, P.C. (NPI 1174858419) is a healthcare organization registered as an oral and maxillofacial surgery in Fulton, New York and active in the NPI registry since October 2009. The organization lists David A. Macgregor, Owner, as its authorized official.

NPPES Registry Identity

NPI1174858419
Entity TypeOrganization
Primary Taxonomy1223S0112X
Legal Business NameGREAT LAKES ORAL SURGERY, P.C.
Location Address633 W. 3RD ST. S.Fulton, NY 13069
Mailing Address633 W. 3rd St. S.Fulton, NY 13069 · (315) 343-6160 · Fax (315) 343-8556
Fax(315) 343-8556
Organization SubpartNo
Authorized OfficialDavid A. MacgregorOwner · (315) 343-6160
Enumeration DateOctober 5, 2009
Last NPPES UpdateJanuary 31, 2019
NPI 1174858419 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
License Licensed in NY · 051594
Definition

An oral and maxillofacial surgery dentist specialized in 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.

633 W. 3RD ST. S., Fulton, NY 13069

Other Identifiers 1

Medicaid03118614NY

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Dentist (Oral and Maxillofacial Surgery)
633 W. 3RD ST. S.
FULTON, NY 13069

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1174858419, enumerated as an "organization" on October 05, 2009.

The provider is located at 633 W. 3RD ST. S. FULTON, NY 13069 and the phone number is (315) 343-6160.

Dentist with taxonomy code 1223S0112X and a focus in Oral and Maxillofacial Surgery.

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.