Organization
AVON ORAL AND MAXILLOFACIAL SURGERY, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BARBARA HINMAN (OFFICE MANAGER)
(860) 674-8079
Entity
Organization
Contact information
Practice address
34 DALE RD, SUITE 105, AVON, CT 06001-3659
(860) 674-8079
(860) 676-8242
Mailing address
34 DALE RD, SUITE 105, AVON, CT 06001-3659
(860) 674-8079
(860) 676-8242
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
008732
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001388207
—
CT
05
—
002064939
—
CT
05
—
002087329
—
CT
05
—
004206977
—
CT
05
—
004397718
—
CT
Enumeration date
04/20/2007
Last updated
02/08/2021
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