Organization
NORWICH ORAL & MAXILLOFACIAL SURGEONS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA KEENEY (OFFICE MANAGER)
(860) 886-0651
Entity
Organization
Contact information
Practice address
130 NEW LONDON TPKE, NORWICH, CT 06360-2624
(860) 886-0651
(860) 823-1577
Mailing address
130 NEW LONDON TPKE, NORWICH, CT 06360-2624
(860) 886-0651
(860) 823-1577
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004083333
—
CT
Enumeration date
09/18/2007
Last updated
11/10/2011
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