Healthcare Provider Details

I. General information

NPI: 1760425904
Provider Name (Legal Business Name): CHRISTOPHER JOSEPH CUOMO D.D.S., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDGEWOOD PROFESSIONAL CENTER 27 HOSPITAL AVE., SUITE 306
DANBURY CT
06810
US

IV. Provider business mailing address

16 CANNON DR
NEWTOWN CT
06470-1751
US

V. Phone/Fax

Practice location:
  • Phone: 203-797-0008
  • Fax:
Mailing address:
  • Phone: 919-360-7098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number009561
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number051027-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number07122
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: