MEDICARE: NEW HAVEN ORAL & MAXILLOFACIAL SURGERY ASSOC. PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	4184	CT

General Provider Information

NPI Number	:	1437346632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW HAVEN ORAL & MAXILLOFACIAL SURGERY ASSOC. PC

Provider Business Mailing Address
First Line	:	310 MAIN ST
Second Line	:
City	:	EAST HAVEN
State	:	CT
Zip	:	06512-2919
Country	:	US
Telephone Number	:	203-468-7181
Fax Number	:	203-469-8058

Provider Business Practice Location Address
First Line	:	310 MAIN ST
Second Line	:
City	:	EAST HAVEN
State	:	CT
Zip	:	06512-2919
Country	:	US
Telephone Number	:	203-468-7181
Fax Number	:	203-469-8058

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RONALD RICHARD MONTANO
Credential	:	D.D.S.
Telephone Number	:	203-469-8057

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	10/02/2007

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