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General NPI Number Information
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NPI Number | 1992109656
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Entity Type | Organization
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Legal Business Name | NEW HAVEN IMPLANT AND ORAL SURGERY, LLC
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Dates
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Enumeration Date | 10/09/2014
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 1423 CHAPEL ST UNIT 3C
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City | NEW HAVEN
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State | CT
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Zip | 06511-4411
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Country | US
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Telephone | 203-787-6581
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Fax |
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Provider Business Mailing Address
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Address Line | 1423 CHAPEL ST UNIT 3C
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City | NEW HAVEN
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State | CT
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Zip | 06511-4411
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Country | US
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Telephone | 203-787-6581
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Fax |
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Authorized Official
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Title or Position | MEMBER/PRESIDENT
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Name | DR. JORDAN GREENBERG
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Credential | D.D.S.
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Telephone | 914-355-0840
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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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