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General NPI Number Information
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NPI Number | 1639352396
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Entity Type | Organization
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Legal Business Name | ORAL SURGEONS ASSOCIATES, P.C
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Dates
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Enumeration Date | 12/17/2007
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 10 MOTT AVE
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City | NORWALK
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State | CT
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Zip | 06850-3320
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Country | US
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Telephone | 203-853-0500
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Fax | 203-853-0501
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Provider Business Mailing Address
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Address Line | 10 MOTT AVE
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City | NORWALK
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State | CT
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Zip | 06850-3320
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Country | US
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Telephone | 203-853-0500
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Fax | 203-853-0501
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALAN R RISSOLO
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Credential | D.M.D
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Telephone | 203-853-0500
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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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