# MOFS-CT ORAL FACIAL SURGERY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Dental Oral Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861920068
- **Authorized official:** DR. JANET C BODEY DDS (MANAGING MEMBER)
- **Authorized official phone:** (203) 998-7470

## Contact information

- **Practice address:** 1 BOULDER AVE, OLD GREENWICH, CT 06870-1420
- **Practice address phone:** (203) 990-3300
- **Practice address fax:** (212) 202-6447
- **Mailing address:** 6118 RIVERDALE AVE, BRONX, NY 10471-1009
- **Mailing address phone:** (203) 998-7470
- **Mailing address fax:** (212) 202-6447

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 9973 | CT | Yes |

## Other

- **Enumeration date:** 06/01/2017
- **Last updated:** 06/01/2017