Provider Demographics
NPI:1992916787
Name:ASSOCIATED ORAL AND MAXILLOFACIAL SURGEONS
Entity type:Organization
Organization Name:ASSOCIATED ORAL AND MAXILLOFACIAL SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:BADWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:203-797-0012
Mailing Address - Street 1:107 NEWTOWN RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4146
Mailing Address - Country:US
Mailing Address - Phone:203-797-0012
Mailing Address - Fax:203-797-0123
Practice Address - Street 1:107 NEWTOWN RD.
Practice Address - Street 2:SUITE 1A
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-797-0012
Practice Address - Fax:203-797-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001364190Medicaid
CT001364190Medicaid
CTU79623Medicare UPIN