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General NPI Number Information
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NPI Number | 1083173538
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Entity Type | Organization
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Legal Business Name | RIDGEFIELD ORAL AND MAXILLOFACIAL SURGERY, LLC
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Dates
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Enumeration Date | 03/14/2019
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Last Update Date | 03/14/2019
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Provider Practice Location Address
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Address Line | 10 SOUTH ST STE 202
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City | RIDGEFIELD
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State | CT
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Zip | 06877-4125
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Country | US
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Telephone | 203-403-3686
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Fax |
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Provider Business Mailing Address
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Address Line | 87 BROOKHOLLOW LN
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City | STAMFORD
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State | CT
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Zip | 06902-1014
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Country | US
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Telephone | 617-230-1152
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN EDWARD SMULLIN
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Credential | DMD, MD
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Telephone | 203-403-3686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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