Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery |
| NPI # | 1356362370 |
| LBN Legal business name | CONNECTICUT VALLEY ORAL SURGERY ASSOCIATES, PC |
| Authorized official | CANDY EBBIGHAUSEN - (ADMINISTRATOR) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 07/22/2006 |
| Last updated | 12/15/2022 - About 3 years ago |
| Identifiers | n/a |
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