Organization
ORAL AND MAXILLOFACIAL SURGICAL ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT RUSSELL SORRENTINO DMD (PRESIDENT)
(203) 787-6581
Entity
Organization
Contact information
Practice address
1423 CHAPEL ST, THIRD FLOOR, NEW HAVEN, CT 06511-4411
(203) 787-6581
(203) 782-6389
Mailing address
1423 CHAPEL ST, THIRD FLOOR, NEW HAVEN, CT 06511-4411
(203) 787-6581
(203) 782-6389
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5139
CT
Other
Enumeration date
07/12/2011
Last updated
07/12/2011
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