| Oral Surgery Associates, L.l.c | |
|
4747 Main St Bridgeport CT 06606-1804 | |
| (203) 371-5595 | |
| Not Available |
| Full Name | Oral Surgery Associates, L.l.c |
|---|---|
| Speciality | Dentist |
| Location | 4747 Main St, Bridgeport, Connecticut |
| Authorized Official Name and Position | Stacey L Whelan (INSURANCE COORDINATOR) |
| Authorized Official Contact | 2033715595 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oral Surgery Associates, L.l.c 4747 Main Street Bridgeport CT 06606 Ph: (203) 371-5595 | Oral Surgery Associates, L.l.c 4747 Main St Bridgeport CT 06606-1804 Ph: (203) 371-5595 |
| NPI Number | 1184634313 |
|---|---|
| Provider Enumeration Date | 08/09/2006 |
| Last Update Date | 10/01/2007 |
| Medicare PECOS PAC ID | 7810160025 |
|---|---|
| Medicare Enrollment ID | O20111103000842 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184634313 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 4982 (Connecticut) | Primary |
| Provider Name | Abed Alkhatib |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1174795751 PECOS PAC ID: 2264605476 Enrollment ID: I20120507000084 |
| Provider Name | Robert P Horne |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1710988993 PECOS PAC ID: 5597920256 Enrollment ID: I20140618000583 |
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