Provider Demographics
NPI:1033136825
Name:GREATER WATERBURY ORAL & MAXILLOFACIAL SURGEONS LLC
Entity Type:Organization
Organization Name:GREATER WATERBURY ORAL & MAXILLOFACIAL SURGEONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HILLGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-573-1427
Mailing Address - Street 1:1389 W MAIN ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3104
Mailing Address - Country:US
Mailing Address - Phone:203-573-1427
Mailing Address - Fax:203-574-2460
Practice Address - Street 1:1389 W MAIN ST
Practice Address - Street 2:SUITE 320
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3104
Practice Address - Country:US
Practice Address - Phone:203-573-1427
Practice Address - Fax:203-574-2460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty