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General NPI Number Information
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NPI Number | 1104183409
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Entity Type | Organization
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Legal Business Name | CENTRAL CTONNECTICUT ORAL MAXILLOFACIAL& IMPLANT SURGERY, PC
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Dates
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Enumeration Date | 04/12/2012
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Last Update Date | 02/18/2014
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Provider Practice Location Address
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Address Line | 836 FARMINGTON AVE SUITE 223
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1505
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Country | US
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Telephone | 860-586-8507
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Fax | 860-586-8697
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Provider Business Mailing Address
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Address Line | 836 FARMINGTON AVE SUITE 223
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1505
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Country | US
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Telephone | 860-586-8507
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Fax | 860-586-8697
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Authorized Official
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Title or Position | ORAL SURGEON
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Name | DR. JOSEPH R HOWARD
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Credential | D.D.S., M.D.
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Telephone | 860-586-8507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State | NULL
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