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General NPI Number Information
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NPI Number | 1407455538
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Entity Type | Organization
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Legal Business Name | NEW: GLASTONBURY ORAL AND IMPLANT SURGERY PLLC
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Dates
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Enumeration Date | 10/20/2020
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 131 NEW LONDON TURNPIKE
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City | GLASTONBURY
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State | CT
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Zip | 06033-7042
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Country | US
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Telephone | 860-659-2623
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Fax |
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Provider Business Mailing Address
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Address Line | 483 MIDDLE TPKE W STE 102
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City | MANCHESTER
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State | CT
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Zip | 06040-3864
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Country | US
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Telephone | 860-649-2272
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Fax | 860-533-1010
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Authorized Official
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Title or Position | OWNER/OMS
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Name | DR. RYAZ ANSARI
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Credential | D.D.S.
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Telephone | 860-649-0227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State |
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