# COVENTRY ORAL AND IMPLANT SURGERY PLLC

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

## Provider details

- **NPI number:** 1811686322
- **Authorized official:** DR. RYAZ ANSARI DDS (OWNER)
- **Authorized official phone:** (860) 649-2272

## Contact information

- **Practice address:** 1572 BOSTON TPKE, COVENTRY, CT 06238-1205
- **Practice address phone:** (860) 649-2272
- **Mailing address:** 483 MIDDLE TPKE W STE 102, MANCHESTER, CT 06040-3864
- **Mailing address phone:** (860) 649-2272

## 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:** 05/02/2023
- **Last updated:** 05/02/2023