Organization
GM SURGICAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN THOMAS MERIAM DDS (MEMBER)
(917) 282-0647
Entity
Organization
Contact information
Practice address
130 NEW LONDON TPKE STE 3, NORWICH, CT 06360-2624
(860) 886-0651
Mailing address
23 MEADOWBROOK RD, MADISON, CT 06443-2557
(203) 787-6581
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285869107
—
CT
05
—
1629218961
—
CT
Enumeration date
06/28/2017
Last updated
06/28/2017
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