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General NPI Number Information
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NPI Number | 1235257148
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Entity Type | Organization
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Legal Business Name | ORAL & MAXILLOFACIAL SURGERY ASSOCIATES OF GREATER NEW HAVEN, P.C.
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 136 SHERMAN AVE SUITE #402
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City | NEW HAVEN
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State | CT
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Zip | 06511-5238
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Country | US
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Telephone | 203-865-0807
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Fax | 203-562-4922
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Provider Business Mailing Address
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Address Line | 136 SHERMAN AVE SUITE #402
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City | NEW HAVEN
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State | CT
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Zip | 06511-5238
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Country | US
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Telephone | 203-865-0807
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Fax | 203-562-4922
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LEONARD WARREN SKOPE
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Credential | DDS
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Telephone | 203-865-0807
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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 | 005198
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License Number State | CT
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