Provider Demographics
NPI:1073600706
Name:THE CENTER FOR ORAL AND MAXILLOFACIAL SURGERY PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:THE CENTER FOR ORAL AND MAXILLOFACIAL SURGERY PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:H
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-298-7557
Mailing Address - Street 1:16 AIRPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03784-1681
Mailing Address - Country:US
Mailing Address - Phone:603-298-7557
Mailing Address - Fax:888-857-3155
Practice Address - Street 1:16 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:WEST LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1681
Practice Address - Country:US
Practice Address - Phone:603-298-7557
Practice Address - Fax:888-857-3155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty