# RIDGEFIELD ORAL AND MAXILLOFACIAL SURGERY, LLC

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

## Provider details

- **NPI number:** 1083173538
- **Authorized official:** DR. STEVEN EDWARD SMULLIN DMD, MD (OWNER)
- **Authorized official phone:** (203) 403-3686

## Contact information

- **Practice address:** 10 SOUTH ST STE 202, RIDGEFIELD, CT 06877-4125
- **Practice address phone:** (203) 403-3686
- **Mailing address:** 87 BROOKHOLLOW LN, STAMFORD, CT 06902-1014
- **Mailing address phone:** (617) 230-1152

## Taxonomy

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

## Other

- **Enumeration date:** 03/14/2019
- **Last updated:** 03/14/2019