# ORAL AND MAXILLOFACIAL SURGICAL ASSOCIATES, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063700037
- **Authorized official:** DR. ROBERT RUSSELL SORRENTINO DMD (PRESIDENT)
- **Authorized official phone:** (203) 787-6581

## Contact information

- **Practice address:** 1423 CHAPEL ST, THIRD FLOOR, NEW HAVEN, CT 06511-4411
- **Practice address phone:** (203) 787-6581
- **Practice address fax:** (203) 782-6389
- **Mailing address:** 1423 CHAPEL ST, THIRD FLOOR, NEW HAVEN, CT 06511-4411
- **Mailing address phone:** (203) 787-6581
- **Mailing address fax:** (203) 782-6389

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 5139 | CT | Yes |

## Other

- **Enumeration date:** 07/12/2011
- **Last updated:** 07/12/2011