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General NPI Number Information
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NPI Number | 1811387863
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Entity Type | Organization
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Legal Business Name | WEST HARTFORD ORAL AND IMPLANT SURGERY PLLC
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Dates
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Enumeration Date | 01/29/2015
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 483 MIDDLE TPKE W
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City | MANCHESTER
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State | CT
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Zip | 06040-3863
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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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Provider Business Mailing Address
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Address Line | 483 MIDDLE TURNPIKE WEST SUITE 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 | 860-232-4606
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Fax | 860-233-8359
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | LISA HARRISON
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Credential |
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Telephone | 860-646-2272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 009050
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License Number State | CT
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Taxonomy #2
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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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