# CENTRAL CONNECTICUT OROFACIAL SLEEP MEDICINE INC

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

## Provider details

- **NPI number:** 1225508526
- **Authorized official:** RAQUEL FONTAINE (BUSINESS MANAGER)
- **Authorized official phone:** (860) 430-5687

## Contact information

- **Practice address:** 55 NYE RD STE 101, GLASTONBURY, CT 06033-1281
- **Practice address phone:** (860) 430-5687
- **Mailing address:** 55 NYE RD STE 101, GLASTONBURY, CT 06033-1281
- **Mailing address phone:** (860) 430-5687

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | NULL | Yes |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | — | Yes |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | NULL | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | — | — |
| 207QS1201X | Sleep Medicine (Family Medicine) Physician | — | NULL | — |
| 207QS1201X | Sleep Medicine (Family Medicine) Physician | — | — | — |
| 208VP0000X | Pain Medicine Physician | — | NULL | — |
| 208VP0000X | Pain Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 11/29/2018
- **Last updated:** 11/29/2018