# NORWICH ORAL & MAXILLOFACIAL SURGEONS, PC

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

## Provider details

- **NPI number:** 1215123807
- **Authorized official:** TERESA KEENEY (OFFICE MANAGER)
- **Authorized official phone:** (860) 886-0651

## Contact information

- **Practice address:** 130 NEW LONDON TPKE, NORWICH, CT 06360-2624
- **Practice address phone:** (860) 886-0651
- **Practice address fax:** (860) 823-1577
- **Mailing address:** 130 NEW LONDON TPKE, NORWICH, CT 06360-2624
- **Mailing address phone:** (860) 886-0651
- **Mailing address fax:** (860) 823-1577

## 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:** 09/18/2007
- **Last updated:** 11/10/2011