Organization
CENTRAL CONNECTICUT OROFACIAL SLEEP MEDICINE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAQUEL FONTAINE (BUSINESS MANAGER)
(860) 430-5687
Entity
Organization
Contact information
Practice address
55 NYE RD STE 101, GLASTONBURY, CT 06033-1281
(860) 430-5687
Mailing address
55 NYE RD STE 101, GLASTONBURY, CT 06033-1281
(860) 430-5687
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
207QS1201X
Sleep Medicine (Family Medicine) Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
Other
Enumeration date
11/29/2018
Last updated
11/29/2018
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