| Connecticut Oral & Maxillofacial Surgery Centers, Llc | |
|
323 Main St West Haven CT 06516-4424 | |
| (203) 937-7181 | |
| (203) 937-1940 |
| Full Name | Connecticut Oral & Maxillofacial Surgery Centers, Llc |
|---|---|
| Speciality | Dentist |
| Location | 323 Main St, West Haven, Connecticut |
| Authorized Official Name and Position | Jeffrey S. Berkley (OWNER) |
| Authorized Official Contact | 2039377181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Connecticut Oral & Maxillofacial Surgery Centers, Llc 323 Main St West Haven CT 06516-4424 Ph: (203) 937-7181 | Connecticut Oral & Maxillofacial Surgery Centers, Llc 323 Main St West Haven CT 06516-4424 Ph: (203) 937-7181 |
| NPI Number | 1083818710 |
|---|---|
| Provider Enumeration Date | 06/14/2007 |
| Last Update Date | 10/03/2007 |
| Medicare PECOS PAC ID | 4486568409 |
|---|---|
| Medicare Enrollment ID | O20031114000146 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083818710 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 7026 (Connecticut) | Primary |
| Provider Name | Marie C Boucher |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1083793210 PECOS PAC ID: 3072533645 Enrollment ID: I20051128000507 |
| Provider Name | Jeffrey S Berkley |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1699854810 PECOS PAC ID: 2264346287 Enrollment ID: I20081022000680 |
| Provider Name | Susan Lee |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1780887281 PECOS PAC ID: 1951626928 Enrollment ID: I20150216000170 |
| Provider Name | Babak Hakimizadeh |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1841447778 PECOS PAC ID: 0042506404 Enrollment ID: I20160912000156 |
| Provider Name | Erik M Sayles |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1457598138 PECOS PAC ID: 9234274309 Enrollment ID: I20161007000414 |
| Provider Name | Scott Claiborne |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1437387305 PECOS PAC ID: 1658639307 Enrollment ID: I20171229001222 |
| Provider Name | Nam K Hoang |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1255853446 PECOS PAC ID: 1850663063 Enrollment ID: I20220721000787 |
| Provider Name | Gerardo P Romeo |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1194977611 PECOS PAC ID: 3779725353 Enrollment ID: I20220812000350 |
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