# CONNECTICUT MAXILLOFACIAL SURGEONS, LLC

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

## Provider details

- **NPI number:** 1285651133
- **Authorized official:** SCHANTAL MARY THIELKE RDA (BILLING & INSURANCE MANAGER)
- **Authorized official phone:** (860) 678-7528

## Contact information

- **Practice address:** 291 FARMINGTON AVE, FARMINGTON, CT 06032-1925
- **Practice address phone:** (860) 678-7528
- **Practice address fax:** (860) 678-7933
- **Mailing address:** 291 FARMINGTON AVE, FARMINGTON, CT 06032-1925
- **Mailing address phone:** (860) 678-7528
- **Mailing address fax:** (860) 678-7933

## 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:** 07/16/2006
- **Last updated:** 07/21/2025