Provider Demographics
NPI:1588381685
Name:MOUNT KISCO ORAL SURGERY PLLC
Entity type:Organization
Organization Name:MOUNT KISCO ORAL SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:HOROWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-710-1917
Mailing Address - Street 1:103 S BEDFORD RD STE 205
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3453
Mailing Address - Country:US
Mailing Address - Phone:914-689-7550
Mailing Address - Fax:
Practice Address - Street 1:103 S BEDFORD RD STE 205
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3453
Practice Address - Country:US
Practice Address - Phone:914-689-7550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty