Individual
DR. CRAIG ALLEN STASULIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D., M.D.
Contact information
Practice address
435 WILLARD AVE UNIT D, NEWINGTON, CT 06111-2318
(860) 796-1329
Mailing address
435 WILLARD AVE UNIT D, NEWINGTON, CT 06111-2318
(860) 796-1329
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
009948
CT
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
48060
CT
Other
Enumeration date
08/30/2007
Last updated
10/28/2019
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