# CRAIG A. STASULIS DMD, MD, ORAL AND MAXILLOFACIAL SURGERY, INC

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

## Provider details

- **NPI number:** 1881237402
- **Authorized official:** DR. CRAIG ALLEN STASULIS DMD, MD (OWNER)
- **Authorized official phone:** (860) 500-7995

## Contact information

- **Practice address:** 435 WILLARD AVE UNIT D, NEWINGTON, CT 06111-2318
- **Practice address phone:** (860) 796-1329
- **Mailing address:** 435 WILLARD AVE UNIT D, NEWINGTON, CT 06111-2318
- **Mailing address phone:** (860) 796-1329

## 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:** 10/27/2019
- **Last updated:** 02/25/2020