Provider Demographics
NPI:1194987008
Name:STONEGATE ORAL SURGERY, LLP
Entity type:Organization
Organization Name:STONEGATE ORAL SURGERY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CASSARA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:585-254-5360
Mailing Address - Street 1:2005 LYELL AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-2323
Mailing Address - Country:US
Mailing Address - Phone:585-254-5360
Mailing Address - Fax:
Practice Address - Street 1:2005 LYELL AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-2323
Practice Address - Country:US
Practice Address - Phone:585-254-5360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033748-11223S0112X
NY0359021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ100023066Medicare UPIN