Healthcare Provider Details

I. General information

NPI: 1568394914
Provider Name (Legal Business Name): CONNECTICUT ORAL AND FACIAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 TECHNOLOGY DR UNIT B101
TRUMBULL CT
06611-6338
US

IV. Provider business mailing address

115 TECHNOLOGY DR UNIT B101
TRUMBULL CT
06611-6338
US

V. Phone/Fax

Practice location:
  • Phone: 203-261-7800
  • Fax: 203-261-8778
Mailing address:
  • Phone: 203-261-7800
  • Fax: 203-261-8778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH GULKO
Title or Position: PRESIDENT
Credential: DDS, MD
Phone: 267-991-2241