Provider Demographics
NPI:1063609105
Name:STAMFORD ORAL & MAXILLOFACIAL SURGERY ASSOC PC
Entity type:Organization
Organization Name:STAMFORD ORAL & MAXILLOFACIAL SURGERY ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-325-2661
Mailing Address - Street 1:27 BRIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-4597
Mailing Address - Country:US
Mailing Address - Phone:203-325-2661
Mailing Address - Fax:203-323-5611
Practice Address - Street 1:27 BRIDGE STREET
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-4597
Practice Address - Country:US
Practice Address - Phone:203-325-2661
Practice Address - Fax:203-323-5611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C01366Medicare PIN