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General NPI Number Information
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NPI Number | 1982811667
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Entity Type | Organization
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Legal Business Name | ORAL AND MAXILLOFACIAL SURGEONS, P.C.
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 80 S MAIN ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3648
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Country | US
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Telephone | 860-347-6939
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Fax | 860-347-7933
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Provider Business Mailing Address
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Address Line | 80 S MAIN ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3648
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Country | US
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Telephone | 860-347-6939
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Fax | 860-347-7933
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Authorized Official
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Title or Position | BUSINESS ADMINISTRATOR
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Name | MRS. HARRIET LOUISE SPERLING
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Credential |
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Telephone | 860-347-6939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D04158
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License Number State | CT
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