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NPI Code Detail

MEDICARE: NORWICH ORAL & MAXILLOFACIAL SURGEONS, PC

MEDICARE: NORWICH ORAL & MAXILLOFACIAL SURGEONS, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223S0112XOral and Maxillofacial Surgery (Dentist)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215123807
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORWICH ORAL & MAXILLOFACIAL SURGEONS, PC
Provider Business Mailing Address
First Line : 130 NEW LONDON TPKE
Second Line :
City : NORWICH
State : CT
Zip : 06360-2624
Country : US
Telephone Number : 860-886-0651
Fax Number : 860-823-1577
Provider Business Practice Location Address
First Line : 130 NEW LONDON TPKE
Second Line :
City : NORWICH
State : CT
Zip : 06360-2624
Country : US
Telephone Number : 860-886-0651
Fax Number : 860-823-1577
Authorized Official
Title or Position : OFFICE MANAGER
Name : TERESA KEENEY
Credential :
Telephone Number : 860-886-0651
Provider Enumeration Date : 09/18/2007
Last Update Date : 11/10/2011

Similar Medicare Providers

1275527772 — DR. STEVEN L BERKE DMD
Practice Location Address:
130 NEW LONDON TPKE
NORWICH, CT
06360-2624
Practice Phone: 860-886-0651
Practice Fax: 860-823-1577
1164416699 — DR. DONALD A AMARO DDS
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130 NEW LONDON TPKE
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Practice Fax: 860-823-1577
1659323855 — AMR MOHAMED ATEF MD
Practice Location Address:
130 NEW LONDON TPKE
NORWICH, CT
06360-2624
Practice Phone: 860-889-4600
Practice Fax: 860-889-5200
1235289190 — DR. CHRISTOPHER TODD TRAILOR D.M.D.
Practice Location Address:
130 NEW LONDON TPKE
NORWICH, CT
06360-2624
Practice Phone: 860-889-3889
Practice Fax: 860-889-3539
1780727925 — NORWICH CARDIAC MEDICINE LLC
Practice Location Address:
130 NEW LONDON TPKE
NORWICH, CT
06360-2624
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Practice Fax:
1962715169 — KATHARINE TUMAMPOS DECENA MD
Practice Location Address:
130 NEW LONDON TPKE
NORWICH, CT
06360-2624
Practice Phone: 860-889-4600
Practice Fax: 860-889-5200

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