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1477707081 NPI number — MANCHESTER ORAL AND IMPLANT SURGERY PLLC

NPI Number: 1477707081
Health Care Provider/Practitioner: MANCHESTER ORAL AND IMPLANT SURGERY PLLC

Information about “1477707081” NPI (MANCHESTER ORAL AND IMPLANT SURGERY PLLC) exists in 1477707081 in HTML format HTML  |  1477707081 in plain Text format TXT  |  1477707081 in PDF (Portable Document Format) PDF  |  1477707081 in an XML format XML  formats.

NPI Number : 1477707081 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1477707081",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MANCHESTER ORAL AND IMPLANT SURGERY PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "483 MIDDLE TPKE W",
    "SecondLineMailingAddress": "SUITE 102",
    "MailingAddressCityName": "MANCHESTER",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06040-3863",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "860-649-2272",
    "MailingAddressFaxNumber": "860-649-4538",
    "FirstLinePracticeLocationAddress": "483 MIDDLE TURNPIKE WEST",
    "SecondLinePracticeLocationAddress": "SUITE 102",
    "PracticeLocationAddressCityName": "MANCHESTER",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06040-3863",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "860-649-2272",
    "PracticeLocationAddressFaxNumber": "860-649-4538",
    "EnumerationDate": "11/10/2008",
    "LastUpdateDate": "09/04/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HARRISON",
    "AuthorizedOfficialFirstName": "LISA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "860-649-2272",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223S0112X",
        "TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
        "LicenseNumber": "TCONTROLL2454",
        "LicenseNumberStateCode": "CT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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