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CONNECTICUT ORAL SURGERY AND IMPLANT CENTER PLLC NPI 1053951350


NPI Information

NPI: 1053951350
Provider Name: CONNECTICUT ORAL SURGERY AND IMPLANT CENTER, PLLC
Classification: Dentist - 1223S0112X
Entity Type: Organization

Specialization: Oral and Maxillofacial Surgery

CLIA Number: 07D0883793

Address:
314 FLANDERS RD STE 1B
EAST LYME, CT
ZIP 06333
Phone: (860) 739-3133
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CONNECTICUT ORAL SURGERY AND IMPLANT CENTER, PLLC is an oral and maxillofacial surgery dentist in East Lyme, CT. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. CONNECTICUT ORAL SURGERY AND IMPLANT CENTER, PLLC NPI is 1053951350. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

314 FLANDERS RD STE 1B
EAST LYME, CT
ZIP 06333-727
Phone: (860) 739-3133

The provider's authorized official is Seth Matton .
The authorized official title is Surgeon/ Owner and has the following contact phone number (860) 578-0436.

The CLIA number assigned to this NPI record is 07D0883793 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 1/14/2020 and was last updated on 1/14/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223S0112XDentistOral and Maxillofacial SurgeryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11609165521MEDICAIDCONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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